甲状腺乳头状癌超声特征及BRAF基因与颈部淋巴结转移的关系

Ultrasonographic characteristics of papillary thyroid carcinoma and the relationship between BRAF gene and cervical lymph node metastasis

目的:对甲状腺乳头状癌(PTC)的原发病灶超声图像特征及BRAF V600E突变类型与发生颈部淋巴结转移(CLNM)的相关性进行分析。方法:选取2023年5月—12月在解放军联勤保障部队第960医院行PTC根治术的214例患者,术前均行常规超声检查及术前细针穿刺检测BRAF V600E基因突变。根据术后病理分为颈部淋巴结未转移组(102例)和转移组(112例),分析PTC患者CLNM的危险因素。结果:转移组与未转移组相比,男性、多灶性、病灶直径≥7 mm、沙粒样钙化、位置(前)、边界不清晰和血流丰富等占比较高,差异具有统计学意义(P<0.05)。BRAF V600E基因突变结果在未转移组(102例)和转移组(112例)间差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,多灶性(OR=2.442,95%CI:1.208~4.938)、病灶直径(OR=2.488,95%CI:1.249~0.957)和血流丰富(OR=3.255,95%CI:1.646~6.436)均为患者发生转移的独立危险因素(P<0.05),年龄、性别、边界、位置(前)不能作为转移的独立危险因素(P>0.05)。多灶性、病灶直径、血流丰富诊断淋巴结转移的准确率为58.2%、62.9%和71.8%,其中血流诊断灵敏度为65.18%、特异度为78.43%和曲线下面积(AUC)为0.718,高于其他两个因素。BRAF V600E检测基因突变结果在转移组112(83.9%)和未转移组102(79.4%)两组间差异无统计学意义(P>0.05)。结论:PTC病灶直径≥7 mm、多灶性、血流丰富可以独立预测CLNM,而术前BRAF基因突变的结果不能作为CLNM的危险因素。

Objective To investigate papillary carcinoma of thyroid(PTC),the ultrasonographic features of the primary lesions of PTC and the correlation between BRAF V600E mutation types and cervical lymph node metastasis(CLNM)were analyzed.Methods A total of 214 patients who underwent radical PTC operation in the 960th Hospital of PLA Joint Logistic Support Force from May 2023 to December 2023 were selected,and the BRAF V600E gene mutation was detected by routine ultrasonography and fine needle aspiration before surgery.According to the postoperative pathology,the patients were divided into the cervical lymph node non-metastasis group(102 cases)and the metastatic group(112 cases).The risk factors of CLNM in PTC patients were analyzed.Results Compared with the non-metastatic group,the incidence of male,multifocal,lesion diameter≥7 mm,sandy calcification,location(front),unclear boundary and rich blood flow were higher in the metastatic group than in the nonmetastatic group,with statistical significance(P<0.05).There was no significant difference in BRAF V600E mutation between non-metastatic group(102 cases)and metastatic group(112 cases)(P>0.05).Multivariate Logistic regression analysis showed multifocal(OR=2.442,95%CI:1.208-4.938),lesion diameter(OR=2.488,95%CI:1.249-4.957)and rich blood flow(OR=3.255,95%CI:1.646-6.436)were independent risk factors for metastasis(P<0.05),and age,sex,boundary and location(before)could not be used as independent risk factors for metastasis(P>0.05).The accuracy of multifocal,focal diameter and abundant blood flow in the diagnosis of lymph node metastasis were 58.2%,62.9%and 71.8%,among which the diagnostic sensitivity of blood flow was 65.18%,specificity 78.43%and area under the curve(AUC)of 0.718 were higher than the other two factors.There was no significant difference in BRAF V600E gene mutation between the metastasis group 112(83.9%)and the non-metastasis group 102(79.4%)(P>0.05).Conclusion PTC lesion diameter≥7mm,multifocal lesion and rich blood flow can independently predict CLNM,while preoperative BRAF gene mutation can not be used as a risk factor for CLNM.