首页|2种方式联合检测在甲状腺微小乳头状癌术前诊断中的价值

2种方式联合检测在甲状腺微小乳头状癌术前诊断中的价值

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目的 探讨超声引导下细针穿刺细胞学(ultrasound-guided fine needle aspiration cytology，US-FNAB)检查联合BRAF V600E基因突变检测在美国放射学会甲状腺超声影像数据报告系统(the thyroid imaging reporting and data system，TI-RADS)4 类 甲 状 腺 微 小 乳 头 状 癌(papillary thyroid microcarcinoma，PTMC)术前诊断中的价值。方法 以术后病理确诊PTMC为"金标准"，选取 2021 年 1 月—2023 年 6月佛山复星禅诚医院因甲状腺结节评分为TI-RADS 4 类行超声引导下甲状腺穿刺的患者 51 例，按照入院不同时间将标本分为US-FNAB检查组(2021 年 1-10 月)、BRAF V600E基因突变检测组(2021 年 11 月—2022 年 8 月)、联合检测组(2022 年 9 月—2023 年 6 月)，各 17 例。US-FNAB组检查采用US-FNAB检查;BRAF V600E基因突变检测组采用BRAF V600E基因突变检测;联合检测组采用US-FNAB+BRAF V600E基因突变检测。比较 3 组诊断效能，筛选出TI-RADS 4 类PTMC术前诊断最优的检测方法。结果 以术后病理确诊为PTMC为"金标准"，US-FNAB检查组检出PTMC阳性6例，阴性 11 例;BRAF V600E基因突变检测组检出PTMC阳性 7例，阴性 10 例;联合检测组检出PTMC阳性 15 例，阴性 2例。联合检测组诊断TI-RADS 4类PTMC的敏感度、准确率(92。86%、82。35%)高于US-FNAB检查组(35。71%、41。18%)、BRAF V600E基因突变检测组(42。86%、47。06%)，差异有统计学意义(P＜0。05)。联合检测组诊断的特异度、阳性预测值、阴性预测值与US-FNAB检查组、BRAF V600E基因突变检测组比较，差异无统计学意义(P＞0。05)。结论 US-FNAB检查联合BRAF V600E基因突变检测用于TI-RADS 4 类PTMC患者术前诊断中，其敏感性、准确性高，可提高诊断效能，降低漏诊率。
The Value of 2 Modalities of Combined Detection in the Preoperative Diagnosis of Micropapillary Thyroid Cancer
Objective To explore the value of ultrasound-guided fine needle aspiration cytology(US-FNAB)combined with BRAF V600E gene mutation detection in the preoperative diagnosis of the thyroid imaging reporting and data system(TI-RADS)type 4 papillary thyroid microcarcinoma(PTMC).Methods Taking postoperative pathologic diagnosis of PTMC as the"gold standard",51 patients who underwent ultrasound-guided thyroid puncture in Foshan Fosun Chancheng Hospital from January 2021 to June 2023 were selected because their thyroid nodule score was TI-RADS type 4.According to different admission times,the samples were divided into US-FNAB examination group(January to October 2021),BRAF V600E gene mutation detection group(November 2021 to August 2022),and combined detection group(September 2022 to June 2023),with 17 cases each.The US-FNAB group was examined by US-FNAB.BRAF V600E gene mutation detection group was tested by BRAF V600E gene mutation detection.In the combined detection group,US-FNAB+BRAF V600E gene mutation was detected.The diagnostic efficiency of the three groups was compared,and the optimal detection method for preoperative diagnosis of TI-RADS type 4 of PTMC was selected.Results The gold standard was the diagnosis of PTMC by pathological examination.6 cases were positive and 11 cases were negative in US-FNAB examination group.BRAF V600E gene mutation test group detected PTMC positive in 7 cases,negative in 10 cases.In the combined test group,PTMC was positive in 15 cases and negative in 2 cases.The sensitivity and accuracy(92.86%,82.35%)of the preoperative diagnosis of TI-RADS type 4 of PTMC combined test group were higher than those of the US-FNAB test group(35.71%,41.18%)and BRAF V600E gene mutation test group(42.86%,47.06%),the difference was statistically significant(P<0.05).There was no significant difference in diagnostic specificity,positive predictive value and negative predictive value between the combined test group and the US-FNAB test group and BRAF V600E gene mutation test group(P>0.05).Conclusion US-FNAB combined with BRAF V600E gene mutation detection is highly sensitive and accurate in the preoperative diagnosis of TI-RADS type 4 PTMC patients,which can improve the diagnostic efficiency and reduce the rate of missed diagnosis.

ultrasound-guided fine needle aspiration cytologyBRAF V600E gene mutation detectionTI-RADS 4 classesthyroid micropapillary carcinomadiagnostic effectivenessrate of missed diagnosis

陈泳生、王维策、杜国能、王彦、敖颖、罗锦麟

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佛山复星禅诚医院功能科,广东 佛山 528000

超声引导下细针穿刺细胞学 BRAF V600E基因突变检测 TI-RADS 4类 甲状腺微小乳头状癌 诊断效能 漏诊率

佛山市卫生健康局医学科研课题

20230031

2024

10.3969/j.issn.1674-9316.2024.08.026

中国卫生标准管理
《中国卫生标准管理》杂志社

中国卫生标准管理

影响因子：1.374
ISSN：1674-9316
年,卷(期)：2024.15(8)
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