剪切波弹性成像联合BRAF <sup>V600E</sup>预测甲状腺乳头状癌中央区淋巴结转移的价值

doi:10.3877/cma.j.issn.1672-6448.2019.03.011

中华医学超声杂志（电子版） ›› 2019, Vol. 16 ›› Issue (03) : 211 -216. doi: 10.3877/cma.j.issn.1672-6448.2019.03.011

所属专题：文献；

浅表器官超声影像学

剪切波弹性成像联合BRAF ^V600E预测甲状腺乳头状癌中央区淋巴结转移的价值

王珏¹, 闻卿², 贲志飞³, 董汝锋⁴, 戴磊⁵, 黄品同²^,^†(

)

^1. 310009　杭州，浙江大学医学院附属第二医院超声科（目前工作于中国科学院大学宁波华美医院超声科）
^2. 310009　杭州，浙江大学医学院附属第二医院超声科
^3. 315010　中国科学院大学宁波华美医院超声科
^4. 315010　宁波市中医院超声科
^5. 315010　中国科学院大学宁波华美医院甲状腺外科

收稿日期:2018-11-28 出版日期:2019-03-01
通信作者: 黄品同
基金资助:
国家自然科学基金(81527803，81420108018); 宁波市自然基金(2017A610196)

Value of share wave elastography combined with BRAF^V600E in predicting central lymph nodes metastasis of papillary thyroid carcinoma

Jue Wang¹, Qing Wen², Zhifei Ben³, Rufeng Dong⁴, Lei Dai⁵, Pintong Huang²^,^†()

^1. Department of Ultrasound, the Second Aiffiliated Hospital of Zhejiang University School of Medicine, HangZhou 310009, China (now work in the HwaMei Hosptial, University of Chinese Academy of Sciences)
^2. Department of Ultrasound, the Second Aiffiliated Hospital of Zhejiang University School of Medicine, HangZhou 310009, China
^3. Department of Ultrasound, HwaMei Hosptial, University of Chinese Academy of Sciences, Ningbo 315010, China
^4. Department of Ultrasound, Ningbo Municipal Hospital of Traditional Chinese Medicine, Ningbo 315010, China
^5. Department of Ultrasound Thyroid Surgery, HwaMei Hosptial, University of Chinese Academy of Sciences, Ningbo 315010, China

Received:2018-11-28 Published:2019-03-01
Corresponding author: Pintong Huang
About author:
Corresponding author: Huang Pintong, Email: huangpintong@126.com

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王珏, 闻卿, 贲志飞, 董汝锋, 戴磊, 黄品同. 剪切波弹性成像联合BRAF ^V600E预测甲状腺乳头状癌中央区淋巴结转移的价值[J]. 中华医学超声杂志（电子版）, 2019, 16(03): 211-216.

Jue Wang, Qing Wen, Zhifei Ben, Rufeng Dong, Lei Dai, Pintong Huang. Value of share wave elastography combined with BRAF^V600E in predicting central lymph nodes metastasis of papillary thyroid carcinoma[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(03): 211-216.

目的

探讨剪切波弹性成像（SWE）联合BRAF^V600E预测甲状腺乳头状癌（PTC）中央区淋巴结转移的价值。

方法

选取2017年1月至2018年5月浙江大学附属第二医院经手术病理证实为PTC患者217例，共217个结节，所有患者术前均行常规超声检查、SWE、BRAF^V600E检测，术中均行预防性颈部中央区淋巴结清扫。以术后病理结果为"金标准"，采用独立样本t检验比较发生中央区淋巴结转移及未发生中央区淋巴结转移两组间的SWE检查的弹性模量值最大值（Emax）、平均值（Emean）及最小值（Emix）值之间的差异；采用χ²检验比较BRAF^V600E突变者与未突变者发生中央区淋巴结转移的差异；绘制受试者工作特征ROC曲线比较SWE各参数及其联合BRAF^V600E预测PTC中央区淋巴结转移的效能。

结果

两组间的Emax、Emean、Emin比较，差异均有统计学意义（t=4.49、8.11、3.23，P均<0.01），且Emean预测效能优于Emax、Emin。BRAF^V600E突变者与未突变者发生中央区淋巴结转移比较，差异有统计学意义（χ²=16.16，P<0.01）。SWE联合BRAF^V600E预测PTC中央区淋巴结转移特异度、准确性、阴性预测值、阳性预测值均高于单独应用SWE及BRAF^V600E，且差异均有统计学意义（χ²=64.769、35.406、22.647、20.247，P均<0.01）。

结论

SWE与BRAF^V600E联合应用可以显著提高预测PTC中央区淋巴结转移的特异度、准确性、阴性预测值、阳性预测值。

关键词: 甲状腺肿瘤, 剪切波弹性成像, BRAF^V600E基因, 淋巴结转移

Objective

To investigate the value of share wave elastography (SWE) combined with BRAF^V600E in predicting central lymph nodes metastasis of papillary thyroid carcinoma (PTC).

Methods

This study collected 217 PTC from 217 patients diagnosed as PTC by surgical pathology,all patients are confirmed by conventional ultrasonography, SWE examination, BRAF^V600E gene detection and central neck dissection for preventive. Taking postoperative pathological results as gold standard, the independent t test was used to compared the differences in SWE between groups with and without central lymph nodes metastasis; the chi-square test was used to compare the difference of BRAF^V600E between the two groups; and to use the receiver operating characteristic (ROC) curve to investigate the diagnostic efficacy of SWE, BRAF^V600E and their combination in predicting central lymph nodes metastasis of PTC.

Results

The differences of PTC Emax, Emean, Emin between the two groups showed statistically significant (t=4.49, 8.11, 3.23, all P<0.01), and the predictive value of Emean was higher than Emax、Emin. The difference of BRAF^V600E between the two groups showed statistically significant (χ²=16.16, P<0.01). The specificity, accuracy, negative predictive value and positive predictive value of SWE combined with BRAF^V600E were all higher than single SWE and BRAF^V600E with statistical significant (χ²=64.769, 35.406, 22.647, 20.247, all P<0.01).

Conclusions

SWE combined with BRAF^V600E can significantly improve the specificity, accuracy, negative predictive value and positive predictive value in predicting central lymph nodes metastasis of PTC.

Key words: Thyroid neoplasms, Shear wave elastography, BRAF^V600E, Lymphatic metastasis

图1 病理证实PTC伴中央区淋巴结转移患者的超声图像。图a二维声像图；图b SWE质量模式显示可信度为100%；图c SWE速度模式显示Emean：45.75 kPa

图2 病理证实PTC未发生中央区淋巴结转移患者的超声图像。图a二维声像图；图b SWE质量模式显示可信度为100%；图c SWE速度模式显示Emean：22.02 kPa

图3 SWE各参数预测PTC中央区淋巴结转移的受试者工作特征曲线

表1 PTC有无中央区淋巴结转移的Emax、Emean、Emin的比较（kPa，±s）

淋巴结转移	例数	Emax	Emean	Emin
有中央区淋巴结转移	94	64.06±19.73	45.97±13.28	13.10±5.78
无中央区淋巴结转移	123	52.92±16.73	32.67±10.03	10.69±5.18
t值	?	4.49	8.11	3.23
P值	?	<0.01	<0.01	<0.01

表1 PTC有无中央区淋巴结转移的Emax、Emean、Emin的比较（kPa，±s）

淋巴结转移	例数	Emax	Emean	Emin
有中央区淋巴结转移	94	64.06±19.73	45.97±13.28	13.10±5.78
无中央区淋巴结转移	123	52.92±16.73	32.67±10.03	10.69±5.18
t值	?	4.49	8.11	3.23
P值	?	<0.01	<0.01	<0.01

表2 SWE各参数预测中央区淋巴结转移的效能

参数	AUC	95%CI	截断值	敏感度（%）	特异度（%）
Emax	0.673	0.598~0.748	65.92	55.3	82.1
Emean	0.801	0.742~0.860	30.68	86.2	64.2
Emin	0.622	0.546~0.698	9.46	66.0	61.8

表2 SWE各参数预测中央区淋巴结转移的效能

参数	AUC	95%CI	截断值	敏感度（%）	特异度（%）
Emax	0.673	0.598~0.748	65.92	55.3	82.1
Emean	0.801	0.742~0.860	30.68	86.2	64.2
Emin	0.622	0.546~0.698	9.46	66.0	61.8

图4 SWE、BRAF^V600E及两者联合预测中央区淋巴结转移的受试者工作特征曲线

表3 比较SWE、BRAF^V600F及两者联合预测中央区淋巴结转移的效能（%）

诊断模式	敏感度	特异度	准确性	阳性预测值	阴性预测值
Emean	86.2	64.2	73.3	64.8	85.9
BRAF^V600E	90.4	34.1	58.8	51.2	82.3
Emean＋BRAF^V600E	84.0	84.6	84.3	80.6	87.4

表3 比较SWE、BRAF^V600F及两者联合预测中央区淋巴结转移的效能（%）

诊断模式	敏感度	特异度	准确性	阳性预测值	阴性预测值
Emean	86.2	64.2	73.3	64.8	85.9
BRAF^V600E	90.4	34.1	58.8	51.2	82.3
Emean＋BRAF^V600E	84.0	84.6	84.3	80.6	87.4

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Value of share wave elastography combined with BRAF^V600E in predicting central lymph nodes metastasis of papillary thyroid carcinoma

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Value of share wave elastography combined with BRAFV600E in predicting central lymph nodes metastasis of papillary thyroid carcinoma

Value of share wave elastography combined with BRAF^V600E in predicting central lymph nodes metastasis of papillary thyroid carcinoma