US-FNAB联合BRAFV600E基因检测及造影对C-TIRADS 4类甲状腺结节的诊断价值

Diagnostic value of US-FNAB combined with BRAFV600E gene detection and contrast enhanced ultrasonic in C-TIRADS 4 types of thyroid nodules

目的探讨超声引导下细针穿刺抽吸活检(US-FNAB)联合BRAFV600E基因检测及造影对C-TIRADS 4类甲状腺结节的诊断价值。方法收集2020年10月-2022年10月在我院就诊并行甲状腺超声检查归为C-TIRADS 4类的甲状腺结节患者101例(共104个结节)。根据甲状腺结节的常规超声特征,依据C-TIRADS标准对结节进行分类并选取C-TIRADS 4类甲状腺结节,所有病例均进行常规超声、US-FNAB、BRAF V600E基因检测及超声造影检查,病理结果作为本研究“金标准”。采用Kappa一致性检验方法评估US-FNAB以及其联合BRAF V600E基因检测及超声造影与术后病理结果的一致性,计算各自的灵敏度、特异度、阳性预测值、阴性预测值、准确度,评价US-FNAB以及其联合BRAF V600E基因检测及超声造影对C-TIRADS 4类甲状腺结节的诊断效能。结果Kappa一致性检验方法中,US-FNAB、US-FNAB联合BRAF V600E基因、US-FNAB联合超声造影、US-FNAB联合BRAF V600E基因及超声造影检查的Kappa值分别为0.76、0、86、0.88、0.90,均>0.75;计算各自灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为US-FNAB:93.3%、82.8%、93.3%、82.8%、90.4%;US-FNAB联合BRAF V600E基因检测:96.0%、89.7%、96.0%、89.7%、94.2%;US-FNAB联合超声造影:97.3%、89.7%、96.0%、92.9%、95.2%。US-FNAB联合BRAF V600E基因检测以及超声造影:97.3%、93.1%、97.3%、93.1%、96.2%。结论US-FNAB联合BRAFV600E基因检测及造影对C-TIRADS 4类甲状腺结节的具有较高的诊断价值,是临床治疗及预后评估的较为有效的方法。

Objective To investigate the application of US-FNAB combined with BRAFV600E gene detection and angiography in the diagnosis of C-TIRADS 4 thyroid nodules.Methods A total of 101 patients(104 nodules in total)with thyroid nodules were selected.According to the routine ultrasonic characteristics of thyroid nodules,C-TIRADS 4thyroid nodules were selected according to C-TIRADS criteria.All cases underwent routine ultrasound、US-FNAB、BRAF V600E gene detection and contrast-enhanced ultrasound examination,and the pathological results were used as the"gold standard"of this study.Kappa consistency test was used to evaluate the consistency of US-FNAB and its combined BRAF V600E gene detection and contrast-enhanced ultrasound with postoperative pathological results,and their sensitivity,specificity,positive predictive value,negative predictive value and accuracy were calculated.To evaluate the diagnostic efficacy of US-FNAB and its combination with BRAF V600E gene detection and contrast-enhanced ultrasound in C-TIRADS 4thyroid nodule.Results In the Kappa consistency test method,the respective Kappa values were 0.76(US-FNAB),0.86(US-FNAB combined with BRAFV600E gene),0.88(US-FNAB combined with contrast-enhanced ultrasound),0.90(US-FNAB combined with BRAF V600E gene and contrast-enhanced ultrasound),all>0.75;The sensitivity,specificity,positive predictive value,negative predictive value and accuracy respectively were US-FNAB:93.3%,82.8%,93.3%,82.8%,90.4%;US-FNAB combined BRAF V600E gene test:96.0%,89.7%,96.0%,89.7%,94.2%;US-FNAB:combined contrast-enhanced ultrasound:97.3%,89.7%,96.0%,92.9%,95.2%.US-FNAB combined with BRAF V600E gene testing and contrast-enhanced ultrasound:97.3%,93.1%,97.3%,93.1%,96.2%.Conclusion US-FNAB combined with BRAFV600E gene detection and contrast-enhanced ultrasound have high diagnostic value for C-TIRADS type 4 thyroid nodules,which is an effective method for clinical treatment and prognosis assessment.