探索超声引导下细针穿刺洗脱液测定BRAF^V600E突变丰度在预测甲状腺乳头状癌（PTC）颈部淋巴结转移中的临床价值。

收集在上海交通大学医学院附属瑞金医院2020年1月至12月间行甲状腺手术且病理证实为PTC的1046例患者，术前均行超声引导下细针穿刺活检测定BRAF^V600E突变丰度。根据淋巴结转移情况将患者分为淋巴结转移组（419例）和无淋巴结转移组（627例）。采用χ²检验或t检验分析2组患者间的临床特征（性别、年龄、肿瘤最大径、结节数目、结节位置）以及突变丰度之间是否存在差异，并采用二元Logistic回归进行多因素分析，同时构建受试者操作特征（ROC）曲线评估BRAF^V600E基因突变丰度预测PTC患者淋巴结转移的诊断效能。

淋巴结转移组中男性、＜45岁、肿瘤最大径≥1 cm、多发结节数目以及多侧结节比例高于无淋巴结转移组（32.0% vs 19.9%；72.1% vs 54.5%；38.9% vs 19.0%；25.8% vs 18.0%；16.2% vs 10.4%），差异均具有统计学意义（χ²=19.56、32.62、50.63、9.06、7.78；P＜0.001、＜0.001、＜0.001、=0.003、=0.005）；PTC伴有淋巴结转移的BRAF^V600E突变丰度高于无淋巴结转移者［（32.44±20.23）% vs（27.21±20.82）%］，差异具有统计学意义（t=-4.29，P＜0.001）。多因素回归分析结果提示男性、年龄、最大径≥1 cm、多发结节、BRAF^V600E突变丰度高为PTC颈部淋巴结转移的独立危险因素（OR=1.935、0.425、2.578、1.651、2.057；P均＜0.05）。ROC曲线显示BRAF^V600E突变丰度预测颈部淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值和曲线下面积分别为48.69%、65.71%、48.69%、65.71%、0.574。

BRAF^V600E突变丰度高的PTC患者更容易发生淋巴结转移，BRAF^V600E突变丰度高是PTC颈部淋巴结转移的危险因素。

To assess the clinical value of the abundance of BRAF^V600E mutation detected in ultrasound-guided fine needle aspiration samples in predicting cervical lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC).

A total of 1046 patients with pathologically confirmed PTC between January 2020 and December 2020 at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were collected. Ultrasound-guided fine-needle aspiration samples were collected to determine the abundance of BRAF^V600E mutation before surgery. Patients were classified into lymph node metastasis group (n=419) and no lymph node metastasis group (n=627) based on lymph node metastasis. The correlation between clinical characteristics (sex, age, tumor diameter, number of nodes, nodal location, and mutation abundance) and cervical LNM in PTC patients was analyzed using χ² test or t-test. Multifactorial analysis was performed by binary logistic regression analysis, and the diagnostic efficacy of BRAF^V600E mutation abundance in predicting cervical LNM in PTC patients was assessed by constructing receiver operating characteristic (ROC) curves.

The proportions of males, patients＜45 years old, patients with tumor maximum diameter ≥1 cm, patients with multiple nodes, and those with multiple bilateral nodes in patients with cervical LNM was significantly higher than those in patients without (32.0% vs 19.9%, 72.1% vs 54.5%, 38.9% vs 19.0%, 25.8% vs 18.0%, and 16.2% vs 10.4%; χ²=19.56, 32.62, 50.63, 9.06, and 7.78; P＜0.001,＜0.001,＜0.001, =0.003, and =0.005, respectively); the abundance of BRAF^V600E mutation was significantly higher in PTC patients with cervical LNM than in those without [(32.44±20.23)% vs (27.21±20.82) %, t=-4.29, P＜0.001]. Multifactorial regression analysis suggested that male gender, age, maximum diameter ≥1 cm, multiple nodes, and high abundance of BRAF^V600E mutation were independent risk factors for cervical LNM in PTC (OR=1.935, 0.425, 2.578, 1.651, and 2.057, respectively; P＜0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of BRAF^V600E mutation abundance in predicting cervical LNM were 48.69%, 65.71%, 48.69%, 65.71%, and 0.574, respectively.

The detection of BRAF^V600E mutation abundance can provide a reference for clinical decision making in cervical LNM resection in patients with PTC.