甲状腺结节细针穿刺洗脱液透明质酸水平在鉴别诊断甲状腺乳头状癌中的价值

Role of hyaluronan in thyroid nodule fine-needle aspiration washout fluid in differential diagnosis of papillary thyroid cancer

目的探讨超声引导下甲状腺结节细针穿刺(FNA)洗脱液透明质酸(HA)水平在甲状腺乳头状癌辅助诊断中的价值。方法选取2021年9月—2022年3月上海交通大学医学院附属第六人民医院60例行超声引导下甲状腺结节FNA的患者,收集FNA洗脱液。依据甲状腺结节FNA病理诊断结果分为良性结节组(24例)和甲状腺癌组(36例)。检测FNA洗脱液HA水平和FNA洗脱液微量细胞中透明质酸合成酶(HAS)mRNA的表达量。采用受试者工作特征(ROC)曲线评估FNA洗脱液HA诊断甲状腺乳头状癌的效能。结果甲状腺癌组FNA洗脱液HA水平显著高于良性结节组(P<0.001)。甲状腺癌组HAS2 mRNA相对表达量显著高于良性结节组(P<0.05),HAS1 mRNA和HAS3 mRNA相对表达量2个组之间差异无统计学意义(P>0.05)。ROC曲线分析结果显示,FNA洗脱液HA诊断甲状腺乳头状癌的曲线下面积为0.7932,最佳临界值为30.30 ng/mL,敏感性为79.41%,特异性为75.00%。结论甲状腺结节FNA洗脱液HA水平在鉴别诊断良性、恶性甲状腺结节中有一定的价值,或可成为甲状腺乳头状癌辅助诊断标志物。

Objective To determine the role of hyaluronan(HA)in the washout of ultrasound-guided thyroid nodule fine-needle aspiration(FNA)in differential diagnosis of papillary thyroid cancer.Methods Totally,60 patients who underwent ultrasound-guided thyroid nodule FNA were enrolled from Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2021 to March 2022.According to the pathological diagnosis,the patients were classified into 2 groups,benign nodule group(24 cases)and thyroid cancer group(36 cases).The HA level in FNA washout fluid and the expression of hyaluronic acid synthetase(HAS)mRNA in trace cells of FNA washout fluid were determined.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of HA in FNA washout fluid.Results The HA level of FNA washout fluid in thyroid cancer group was higher than that in benign nodule group(P<0.001).The relative expression level of HAS2 mRNA in thyroid cancer group was higher than that in benign nodule group(P<0.05),but there was no statistical significance in the relative expression level of HAS1 mRNA and HAS3 mRNA between the 2 groups(P>0.05).ROC curve analysis showed that the area under curve of HA level was 0.7932.The cut-off value was 30.30 ng/mL,the sensitivity was 79.41%,and the specificity was 75.00%.Conclusions The level of HA in ultrasound-guided thyroid nodule FNA washout fluid plays a role in differential diagnosis of benign and malignant thyroid nodule diseases and may be a potential marker of papillary thyroid cancer.