甲状腺细胞学诊断联合基因检测提高甲状腺乳头状癌诊断率

Thyroid cytological diagnosis combined with gene detection improves the diagnostic rate of papillary thyroid carcinoma

目的:探讨超声引导下细针穿刺细胞学诊断联合BRAF^(V600E)基因检测提高甲状腺乳头状癌检出率的诊断价值。方法:收集2020年5月至2022年12月本院就诊的甲状腺结节患者152例(152个结节),对比细胞学诊断、BRAFV600E基因检测与术后病理结果,观察多种诊断方式联合使用的诊断效能。结果:根据Bethesda分类标准,152个结节中Ⅰ~Ⅵ类结节分别有0个、16个、19个、24个、53个及40个。152份标本行BRAFV600E基因检测结果显示阳性80例、阴性72例;BRAF^(V600E)阴性72例中术后诊断为甲状腺乳头状癌13例。超声引导下细针穿刺细胞学与BRAFV600E基因检查联合诊断的敏感变、特异度、准确性、阳性预测值及阴性预测值显著高于任何单一诊断方式(均P<0.05)。结论:超声引导下细针穿刺细胞学及BRAF^(V600E)基因检测是术前诊断甲状腺乳头状癌的可靠方法,二者联合检测可提高疾病早期检出率,有助于术前准确评估结节良恶性,为疾病手术方案的制定提供参考。

Objective:To investigate the diagnostic value of ultrasound⁃guided fine needle aspiration cytology combined with BRAF^(V600E)gene detection in improving the detection rate of papillary thyroid carcinoma.Methods:A total of 152 patients(152 nodules)with thyroid nodules who were treated in our hospital from May 2020 to December 2022 were collected.The cytological diagnosis,BRAF^(V600E)gene detection and postoperative pathological results were compared,and the diagnostic efficacy of the combined use of multiple diagnostic methods was observed.Results:According to the Bethesda classification criteria,there were 0,16,19,24,53 and 40 nodules in classⅠ-Ⅵnodules,respectively.The results of BRAF^(V600E)gene detection in 152 specimens showed that 80 cases were positive and 72 cases were negative;and among the 72 cases of BRAF^(V600E)negative,13 cases were diagnosed as papillary thyroid carcinoma after operation.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of ultrasound⁃guided fine needle aspiration cytology combined with BRAFV600E gene detection were significantly higher than those of any single diagnostic method(all P<0.05).Conclusion:Ultrasound⁃guided fine needle aspiration cytology and BRAF^(V600E)gene detection are reliable methods for preoperative diagnosis of papillary thyroid carcinoma.Combined detection can improve the early detection rate of the disease,help to accurately evaluate the benign and malignant nodules before surgery,and provide a reference for the formulation of surgical plans for the disease.