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中华医学超声杂志（电子版） ›› 2020, Vol. 17 ›› Issue (12) : 1178 -1182. doi: 10.3877/cma.j.issn.1672-6448.2020.12.006

所属专题： 文献；

浅表器官超声影像学

超声联合BRAFV600E检测对BSRTC Ⅲ类甲状腺结节的诊断价值
王剑翔1, 俞飞虹1,†(), 叶新华1, 杭菁1, 戎荣2, 李霄2   
  1. 1. 210029 南京医科大学第一附属医院超声医学科
    2. 210029 南京医科大学第一附属医院病理科
  • 收稿日期:2020-04-02 出版日期:2020-12-01
  • 通信作者: 俞飞虹

Value of TIRADS combined with BRAFV600E testing for diagnosis of Bethesda category Ⅲ thyroid nodules

Jianxiang Wang1, Feihong Yu1,†(), Xinhua Ye1, Jing Hang1, Rong Rong2, Xiao Li2   

  1. 1. Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing
    2. Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing
  • Received:2020-04-02 Published:2020-12-01
  • Corresponding author: Feihong Yu
  • About author:
    Corresponding author: Yu Feihong, Email:
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王剑翔, 俞飞虹, 叶新华, 杭菁, 戎荣, 李霄. 超声联合BRAFV600E检测对BSRTC Ⅲ类甲状腺结节的诊断价值[J]. 中华医学超声杂志（电子版）, 2020, 17(12): 1178-1182.

Jianxiang Wang, Feihong Yu, Xinhua Ye, Jing Hang, Rong Rong, Xiao Li. Value of TIRADS combined with BRAFV600E testing for diagnosis of Bethesda category Ⅲ thyroid nodules[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(12): 1178-1182.

目的

探讨超声甲状腺影像报告与数据系统（TIRADS）联合BRAFV600E检测对甲状腺细胞病理学Bethesda报告系统（BSRTC）Ⅲ类结节的诊断价值。

方法

选取2016年1月至2019年6月在南京医科大学第一附属医院行超声引导下甲状腺FNA的患者125例，共125个BSRTC Ⅲ类结节。所有结节同时行TIRADS分类和BRAFV600E检测，并经手术病理证实。以手术病理结果为金标准，比较TIRADS、BRAFV600E检测及两者联合对BSRTC Ⅲ类甲状腺结节的诊断价值。

结果

125例患者共计纳入125个甲状腺结节，术后病理结果提示：良性结节76个；恶性结节49个。TIRADS 4c~5鉴别诊断BSRTC Ⅲ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为73.5%、89.5%、81.8%、84.0%、83.2%。BRAFV600E突变检测鉴别BSRTC Ⅲ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为75.5%、100.0%、100.0%、86.4%、90.4%。以TIRADS 4c~5类或BRAFV600E突变型为BSRTC Ⅲ类结节恶性的联合诊断标准，其敏感度、特异度、阳性预测值、阴性预测值及准确性分别为93.9%、89.5%、85.2%、95.8%、91.2%，联合诊断较TIRADS、联合诊断较BRAFV600E具有较高的敏感度（P=0.002，P=0.004）、阴性预测值（P=0.018，P=0.044）。

结论

TIRADS和BRAFV600E检测联合对于BSRTC Ⅲ类结节具有良好的诊断效能，尤其诊断敏感度和阴性预测值高于单独应用TIRADS或BRAFV600E检测。

关键词: 甲状腺结节, 超声检查, 基因突变, 活组织检查, 针吸
Objective

To assess the diagnostic value of the thyroid imaging reporting and data system (TIRADS) combined with BRAFV600E testing in Bethesda system category Ⅲ thyroid nodules.

Methods

A total of 125 patients who underwent ultrasound-guided fine needle aspiration (FNA) at the First Affiliated Hospital of Nanjing Medical University from January 2016 to June 2019 were selected. Each nodule underwent TIRADS classification and BRAFV600E testing and was confirmed by histopathology. The diagnostic efficacy of TIRADS, BRAFV600E testing, and their combination were assessed according to histopathology findings.

Results

A total of 125 nodules from 125 patients were enrolled. According to histopathology findings, 76 nodules were benign and 49 were malignant. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of TIRADS 4c or 5 were 73.5%, 89.5%, 81.8%, 84.0%, and 83.2%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of BRAFV600E mutation were 75.5%, 100.0%, 100.0%, 86.4%, and 90.4%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of the combination of TIRADS 4c or 5 and BRAFV600E mutation were 93.9%, 89.5%, 85.2%, 95.8%, and 91.2%, respectively. The combination of TIRADS 4c or 5 and BRAFV600E mutation significantly increased the sensitivity (P=0.002, P=0.004) and NPV (P=0.018, P=0.044) when compared with either TIRADS or BRAFV600E mutation alone.

Conclusion

Our findings suggest that the combination method has improved sensitivity and NPV and may have great value in differentiating Bethesda system category Ⅲ nodules.

Key words: Thyroid nodule, Ultrasonography, Gene mutation, Biopsy, needle
表1 不同TIRADS分类的甲状腺结节的恶性率
TIRADS分类 例数 恶性率[例（%）]
合计 125 49（39.2）
3 23 1（4.3）
4a 33 4（12.1）
4b 25 8（32.0）
4c 39 31（79.5）
5 5 5（100.0）
图1 甲状腺影像报告与数据系统（TIRADS）分类诊断BSRTC Ⅲ类结节良恶性的ROC曲线
表2 BRAFV600E突变检测与术后病理诊断BSRTC Ⅲ类结节良恶性的结果（例）
BRAFV600E 术后病理 合计
恶性（阳性） 良性（阴性）
合计 49 76 125
突变型（恶性） 37 0 37
野生型（良性） 12 76 88
表3 TIRADS与BRAFV600E检测联合诊断BSRTC Ⅲ类结节良恶性的结果（例）
联合诊断 术后病理 合计
恶性 良性
合计 49 76 125
恶性 46 8 54
良性 3 68 71
表4 TIRADS、BRAFV600E检测和联合诊断对BSRTC Ⅲ类结节良、恶性的诊断效能比较（%）
方法 敏感度 特异度 阳性预测值 阴性预测值 准确性
TIRADS分类 73.5 89.5 81.8 84.0 83.2
BRAFV600E 75.5 100.0 100.0 86.4 90.4
联合诊断 93.9 89.5 85.2 95.8 91.2
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