摘要
目的探讨如何结合超声评分体系及鼠类肉瘤滤过性毒菌致癌同源体B1(BRAF)基因突变检测提高术前精准筛选伴有颈侧区淋巴结转移的高侵袭性甲状腺乳头状微小癌(PTMC)。方法 2016年9月至2019年9月于苏州大学附属第一医院普外科收治的105例行单侧甲状腺癌根治术及中央区、颈侧区淋巴结清扫术的PTMC患者。分析术前超声表征(有无钙化、肿瘤边界的清晰度、肿瘤位置、肿瘤与甲状腺被膜之间的关联)并予以评分,同时结合术前穿刺标本BRAF突变检测。根据术后病理结果,采用单因素和多因素统计学分析超声评分体系、术前BRAF基因检测、以及结合两种方法的预测价值。并采用Logistic回归方程建立筛选模型,并根据三者受试者工作特征(ROC)曲线来评估对高侵袭性PTMC的术前筛选价值。结果术前超声评分体系及术前穿刺标本BRAF检测均能作为高侵袭性PTMC的独立预测因子,超声评分体系在≥2.5分作为临界点,其灵敏度为81.0%,特异度为87.3%。术前穿刺标本的BRAF突变检测也可以提高侵袭性PTMC确诊率,其灵敏度为73.8%,特异度为77.8%。两种方法的联合诊断模型:Logit(P)=1.523×超声评分+2.555×BRAF突变结果(1突变,0未突变)-5.189。根据最大约登指数0.730,选取截断值0.48。诊断效能92.5%,灵敏度为85.7%,特异度为87.3%。结论超声评分体系以及细针穿刺标本的BRAF基因突变检测对高侵袭性PTMC均有提高部分术前筛选价值,结合两者能提高诊断效能,为进一步指定合理治疗方案提供依据。
Objective To explore how to accurately diagnose aggressive thyroid papillary microcarcinoma(PTMC),which have lateral cervical lymph node metastasis before operation by combining ultrasound quantification system and v-raf murine sarcoma viral oncogene homolog B1(BRAF)mutation detection.Methods From September 2016 to September 2019,105 patients diagnosed as PTMC were retrospectively analyzed.Four US features,including calcifications,boundary,position,the relationship between thyroid gland capsule and tumor were analyzed and scored.BRAF mutation detection and final pathological data were also collected.Based on the final pathological results,univariate and multivariate statistics were used to analyze the predictive value of the ultrasonic scoring system,the BRAF detection in fine-needle aspiration biopsy(FNAB)specimens and the two methods combination.The logistic regression equation was used to establish the screen model.And the three methods were also evaluated according to the receiver operating characteristic(ROC)curve.Results Preoperative ultrasound scoring system and preoperative puncture specimen BRAF test can be used as independent predictors of aggressive PTMC.The total scores of the ultrasonic≥2.5 were the delimitation value,its sensitivity was 81.0%,and specificity was 87.3%.BRAF mutations in FNAB specimens can also predict aggressive PTMC,its sensitivity was 73.8%,and specificity was 77.8%.A diagnostic model combining two methods:Logit(P)=1.523×ultrasound score+2.555×BRAF mutation results(1 mutation,0 no mutation)-5.189.A cut-off value was selected 0.48,according to the maximum Yoden index of 0.730.The sensitivity and specificity were 85.7%and 87.3%,respectively,when combined together.The diagnostic efficiency was 92.5%.Conclusion Both ultrasound scoring system and BRAF mutation detection in FNAB specimens have definite preoperative value for aggressive PTMC.The combination of the two methods can improve diagnostic efficiency,to develop a more refined surgical treatment plan.
作者
高尔立
周好
王捷
王阿军
董凤林
过兆基
姜敏
Gao Erli;Zhou Hao;Wang Jie;Wang Ajun;Dong Fenglin;Guo Zhaoji;Jiang Min(Department of General Surgery,the First Affiliated Hospital of Soochow University,Soochow 215006,China;Department of Medical Ultrasound,the First Affiliated Hospital of Soochow University,Soochow 215006,China;Department of Oncology,the First Affiliated Hospital of Soochow University,Soochow 215006,China)
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2020年第4期717-720,共4页
Chinese Journal of Experimental Surgery
基金
国家自然科学基金青年资助项目(81402176)
江苏省科学技术厅自然科学基金(BK20140288)。
关键词
鼠类肉瘤滤过性毒菌致癌同源体B1
甲状腺乳头状微小癌
超声
术前筛选
V-raf murine sarcoma viral oncogene homolog B1
Papillary thyroid microcarcinoma
Ultrasonography
Preoperative diagnosis
