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超声风险分层联合BRAFV600E基因突变检测诊断甲状腺细胞病理学Bethesda报告系统Ⅲ类甲状腺结节的价值

Value of ultrasound risk stratification combined with BRAFV600E gene mutation detection in diagnosing category Ⅲ thyroid nodules in the Bethesda System for Reporting Thyroid Cytopathology

    摘要
  • 摘要:
    目的 探讨超声风险分层联合BRAFV600E基因突变检测在甲状腺细胞病理学Bethesda报告系统(BSRTC)Ⅲ类甲状腺结节诊断中的应用价值。
    方法  158例甲状腺结节患者接受超声检查进行风险分层，同时接受BRAFV600E基因突变检测。以术后病理诊断结果为金标准，分析超声风险分层单用以及与BRAFV600E基因突变检测联用对BSRTC Ⅲ类甲状腺结节的诊断准确性。
    结果 158个甲状腺结节中，经病理证实为恶性结节96个，良性结节62个。超声评估高度可疑恶性结节95个，中度可疑恶性结节63个。BRAFV600E突变型80个，野生型78个，突变型BRAFV600E对恶性甲状腺结节的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为83.33%、100.00%、89.87%、100.00%和79.49%。高度可疑恶性与高度可疑恶性联合突变型BRAFV600E诊断BSRTC Ⅲ类结节的准确性分别为90.51%、93.67%，差异无统计学意义(P>0.05)。中度可疑恶性联合突变型BRAFV600E诊断BSRTC Ⅲ类结节的准确性为39.87%, 高于单用中度可疑恶性的准确性9.49%, 差异有统计学意义(P < 0.05)。
    结论 超声高度风险分层联合BRAFV600E基因突变对BSRTC Ⅲ类甲状腺结节有较高的诊断准确率, BRAFV600E基因突变检测能够提高超声中度风险分层对BSRTC Ⅲ类甲状腺结节的诊断准确率。

     

    Abstract:
    Objective To explore the value of ultrasound risk stratification combined with BRAFV600E gene mutation detection in diagnosing category Ⅲ thyroid nodules in the Bethesda System for Reporting Thyroid Cytopathology (BSRTC).
    Methods A total of 158 patients with thyroid nodules were conducted ultrasound examination for risk stratification and BRAFV600E gene mutation detection. Taking the pathological diagnosis results after operation as the gold standard, the diagnostic accuracies of ultrasound risk stratification alone and its combination with BRAFV600E gene mutation detection in the diagnosis of BSRTC category Ⅲ thyroid nodules were analyzed.
    Results Among 158 thyroid nodules, 96 nodules were malignant and 62 nodules were benign. A total of 95 highly suspected malignant nodules and 63 moderately suspected malignant nodules were evaluated by ultrasonography. There were 80 nodules of mutant type of BRAFV600E and 78 nodules of wild type BRAFV600E, and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of mutant type of BRAFV600E to malignant thyroid nodules were 83.33%, 100.00%, 89.87%, 100.00% and 79.49%, respectively. The accuracies of highly suspected malignant judgment and highly suspected judgment in combination with mutant type of BRAFV600E in diagnosing BSRTC category Ⅲ nodules were 90.51% and 93.67% respectively, and there was no significant difference between two methods (P>0.05). The accuracy of moderate suspicious combined with mutant type of BRAFV600E in the diagnosis of BSRTC category Ⅲ nodules was 39.87%, which was significantly higher than 9.49% of moderate suspected malignant judgment alone (P < 0.05).
    Conclusion Ultrasound high risk stratification combined with BRAFV600E gene mutation has a high diagnostic accuracy for BSRTC category Ⅲ thyroid nodules, and BRAFV600E gene mutation detection can increase the accuracy of ultrasonic diagnosis of BSRTC category Ⅲ thyroid nodules in moderate risk stratification.

     

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