FNAB联合BRAF V600E基因检测术前诊断甲状腺乳头状癌的价值

Value of FNAB combined with BRAF V600Egene test in preopera-tive diagnosis of thyroid papillary carcinoma

目的探讨超声引导下细针穿刺(FNAB)、BRAF V600E基因突变检测单一及联合诊断对甲状腺乳头状癌(PTC)术前诊断的价值。方法选取2020年1月至2022年10月于河南科技大学第一附属医院甲状腺外科行甲状腺手术且术前同时行FNAB及BRAF突变检测的患者216例,其中9例患者穿刺了甲状腺双叶结节。以术后病理结果为金标准,对比两种术前诊断方法单一及联合诊断的价值。结果共225枚结节,术后病理诊断为甲状腺乳头状癌的214例,诊断为结节性甲状腺肿等甲状腺良性病变的结节11枚,BRAF V600E基因突变检测诊断甲状腺乳头状癌的灵敏度为86.9%,特异度为54.5%,FNAB诊断甲状腺乳头状癌的灵敏度81.7%,特异度45.5%。两种诊断方法灵敏度差异无统计学意义(χ^(2)值2.141,P=0.143)。FNAB联合BRAF V600E基因突变检测将诊断灵敏度提高到了97.6%,差异有显著统计学意义(P<0.001)。结论术前FNAB及BRAF基因突变检测两种诊断方法联合后显著提高甲状腺乳头状癌的检出率,避免患者因漏诊而失去最佳手术时机。

Objective To evaluate the value of ultrasound-guided fine needle aspiration(FNAB)and BRAF V600E gene mutation detection in the preoperative diagnosis of papillary thyroid carcinoma(PTC).Methods A total of 216patients who underwent thyroid surgery in the Department of Thyroid Surgery of our hospital from January 2020to October 2022and underwent simultaneous detection of FNAB and BRAF mutations before surgery were selected,among which 9patients had thyroid bilobular nodules punctured.Taking postoperative pathological results as the gold standard,the value of single and combined diagnosis of two kinds of preoperative diagnosis was compared.Results There were a total of 225nodules,214of which were pathologically diagnosed as thyroid papillary carcinoma after operation,and 11nodules were diagnosed as benign thyroid lesions such as nodular goiter.The sensitivity and specificity of BRAF V600Egene mutation detection in the diagnosis of thyroid papillary carcinoma were 86.9%and 54.5%.The sensitivity and specificity of FNAB in the diagnosis of thyroid papillary carcinoma were 81.7%and 45.5%.There was no significant difference in sensitivity between the two diagnostic methods(χ^(2) value 2.141,P=0.143).FNAB combined with BRAF V600Egene mutation detection increased the diagnostic sensitivity to 97.6%with statistically significant difference(P<0.001).Conclusion Preoperative combination of FNAB and BRAF gene mutation detection can significantly improve the detection rate of papillary thyroid carcinoma,so as to avoid the loss of the optimal surgical opportunity due to missed diagnosis.