超声造影联合BRAF基因突变对C-TIRADS 4类甲状腺良恶性结节的鉴别诊断价值

Valueofcontrast-enhanced ultrasound combined with BRAF gene mutation in the differential diagnosis of benign and malignant thyroid nodules in C-TIRADS category 4

目的 探讨超声造影(CEUS)联合BRAF基因突变对中国甲状腺影像报告与数据系统(C-TIRADS)4类甲状腺良恶性结节的鉴别诊断价值。方法 选取我院行CEUS检查并经手术病理证实的甲状腺结节患者126例(共126个结节),术后均行BRAF基因突变检测;其中C-TIRADS 4A类52个,C-TIRADS 4B类36个,C-TIRADS 4C类38个。比较各分类甲状腺结节CEUS特征和BRAF基因突变情况的差异;分析C-TIRADS 4类甲状腺恶性结节CEUS特征与BRAF基因突变的相关性。绘制受试者工作特征(ROC)曲线评估CEUS特征、BRAF基因突变单独及联合诊断C-TIRADS 4类甲状腺恶性结节的效能。结果 C-TIRADS 4B、4C类甲状腺结节低增强(66.67%、73.68%)、不均匀增强(94.44%、89.47%)、向心性增强(97.22%、89.47%)占比均高于C-TIRADS 4A类,差异均有统计学意义(均P<0.05)。126个甲状腺结节中58个发生BRAF基因突变,发生率为46.03%。C-TIRADS 4B、4C类甲状腺结节BRAF基因突变阳性占比高于C-TIRADS 4A类,差异有统计学意义(P<0.05)。C-TIRADS 4类甲状腺恶性结节的CEUS特征(低增强、不均匀增强、向心性增强)与BRAF基因突变阳性呈显著正相关(r=0.793、0.872、0.895,均P<0.05)。ROC曲线分析显示,CEUS特征联合BRAF基因突变诊断C-TIRADS 4类甲状腺恶性结节的曲线下面积(0.973)、敏感性(100%)、特异性(94.60%)均较其单独诊断效能高。结论 CEUS联合BRAF基因突变有助于提高对C-TIRADS 4类甲状腺良恶性结节的鉴别诊断价值。

Objective To investigate the value of contrast-enhanced ultrasound(CEUS)combined with BRAF gene mutation in the differential diagnosis of benign and malignant thyroid nodules in China thyroid imaging reporting and data system(C-TIRADS)category 4.Methods A total of 126 patients with thyroid nodules(126 nodules in total)who underwent CEUS examination in our hospital and were confirmed by surgery and pathology were selected.All patients underwent BRAF gene mutation detection after surgery.Among them,52 nodules of C-TIRADS 4A,36 nodules of C-TIRADS 4B and 38 nodules of C-TIRADS 4C.The differences of CEUS features and BRAF gene mutation of different types of thyroid nodules were compared.The correlation between CEUS features and BRAF gene mutation of C-TIRADS category 4 malignant thyroid nodules was analyzed.Receiver operating characteristic(ROC)curve was drawn to evaluate the efficacy of CEUS features,BRAF gene mutation alone and in combination in the diagnosis of C-TIRADS category 4 malignant thyroid nodules.Results The proportion of low enhancement(66.67%,73.68%),heterogeneous enhancement(94.44%,89.47%),concentric enhancement(97.22%,89.47%)in C-TIRADS 4B and 4C thyroid nodules were significantly higher than those of C-TIRADS 4A(all P<0.05).BRAF gene mutation was found in 58 of 126 thyroid nodules,with an incidence rate of 46.03%.The proportion of BRAF gene mutation in C-TIRADS 4B and 4C thyroid nodules were significantly higher than that of C-TIRADS 4A(P<0.05).CEUS features(low enhancement,heterogeneous enhancement and centripetal enhancement)of C-TIRADS category 4 malignant thyroid nodules were positively correlated with BRAF gene mutation(r=0.793,0.872,0.895,all P<0.05).ROC curve analysis showed that the AUC(0.973),sensitivity(100%),specificity(94.60%)of CEUS features combined with BRAF gene mutation in the diagnosis of C-TIRADS category 4 malignant thyroid nodules were higher than they application alone.Conclusion CEUS combined with BRAF gene mutation could help to improve the differential diagnosis value of C-TIRADS category 4 malignant thyroid nodules.