细针穿刺标本M2型丙酮酸激酶基因检测在甲状腺乳头状癌诊断中的价值

The diagnostic value of M2 pyruvate kinase gene detection in papillary thyroid carcinoma by fine needle aspiration biopsy

目的探讨细针穿刺标本M2型丙酮酸激酶基因检测在甲状腺乳头状癌诊断中的价值。方法对行甲状腺结节细针穿刺检查的120例甲状腺结节患者(125个结节)应用细针穿刺采集标本,采用实时定量聚合酶链反应检测M2型丙酮酸激酶mRNA表达量,采用免疫组化技术检测术后组织中的M2型丙酮酸激酶蛋白表达。结果本组120例患者共计125个结节,其中良性结节37个,甲状腺乳头状癌88个,甲状腺乳头状癌的M2型丙酮酸激酶mRNA表达量显著高于良性结节(P<0.05)。甲状腺乳头状癌的M2型丙酮酸激酶基因表达量在肿瘤最大直径方面存在显著差异(P<0.05),在年龄、性别、结节数目、BRAFV^(600E)基因型、淋巴结转移及美国癌症协会分期方面无统计学差异(P>0.05)。M2型丙酮酸激酶基因诊断甲状腺乳头状癌的特异度为95.7%,敏感度为46.9%,准确度为62.8%,阴性预测值为46.4%,阳性预测值为95.8%;联合检测M2型丙酮酸激酶基因、BRAFV^(600E)基因诊断甲状腺乳头状癌的敏感度、准确度显著高于单独检测M2型丙酮酸激酶基因、BRAFV^(600E)基因(P<0.05)。结论细针穿刺标本M2型丙酮酸激酶基因检测对甲状腺乳头状癌具有较高的诊断特异性,可以将其作为术前诊断的一种主要分子标志物;联合检测M2型丙酮酸激酶基因与BRAFV^(600E)基因则能明显提高诊断效能。

Objective To investigate the diagnostic value of M2 pyruvate kinase(PKM2)gene detection in papillary thyroid carcinoma by fine needle aspiration biopsy.Methods A total of 120 patients(125 nodules)with thyroid nodules were examined by fine needle aspiration.The expression of PKM2 mRNA was detected by real-time quantitative PCR(RT-qPCR),and the expression of PKM2 protein was detected by immunohistochemistry.Results There were 125 nodules in 120 patients,including 37 benign nodules and 88 thyroid papillary carcinoma.The expression of PKM2 mRNA in thyroid papillary carcinoma was significantly higher than that in benign nodules(P<0.05).There was significant difference in PKM2 gene expression in the maximum diameter of thyroid papillary carcinoma(P<0.05),but no significant difference in age,sex,nodule number,BRAFV^(600E) mutation,lymph node metastasis and AJCC stage(P>0.05).The diagnostic specificity of PKM2 gene was 95.7%,sensitivity was 46.9%,accuracy was 62.8%,negative predictive value was 46.4%,positive predictive value was 95.8%;the combined detection of PKM2 gene and BRAFV^(600E) gene could significantly improve the diagnostic sensitivity and accuracy,compared with the single detection of PKM2 gene and BRAFV^(600E) gene(P<0.05).Conclusions In the diagnosis of thyroid papillary carcinoma,the detection of PKM2 gene by fine needle aspiration biopsy has high diagnostic specificity,which can be used as a major molecular marker for preoperative diagnosis;the combined detection of PKM2 gene and BRAFV^(600E) gene can significantly improve the diagnostic efficiency.