中国普外基础与临床杂志

中国普外基础与临床杂志

FNAC 检查联合 BRAFV600E 基因检测对甲状腺癌颈部淋巴结转移的诊断价值

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目的 探讨细针穿刺细胞学(FNAC)检查联合 BRAFV600E 基因检测对甲状腺癌颈部淋巴结转移的诊断价值。 方法 回顾性收集 2016 年 1 月至 2017 年 6 月期间于江苏省中西医结合医院行甲状腺癌根治术的 140 例甲状腺癌患者,所有患者术前均行超声引导下颈部淋巴结 FNAC 检查以及 BRAFV600E 基因检测。以术后病理检查为“金标准”,分析 FNAC 检查和 BRAFV600E 基因检测单独及联用对甲状腺癌淋巴结转移的诊断价值。 结果 淋巴结 FNAC 诊断甲状腺癌淋巴结转移的的灵敏度为 63.6%(84/132),特异度为 100%(8/8),准确率为 65.7%(92/140),阳性预测值为 100%(84/84),阴性预测值为 14.3%(8/56)。BRAFV600E 基因检测诊断甲状腺癌淋巴结转移的灵敏度为 84.8%(112/132),特异度为 100%(8/8),准确率为 85.7%(120/140),阳性预测值为 100%(112/112),阴性预测值为 28.5%(8/28)。FNAC 检查联合 BRAFV600E 基因检测诊断甲状腺癌淋巴结转移的的灵敏度为 90.9%(120/132),特异度为 100%(8/8),准确率为 91.4%(128/140),阳性预测值为 100%(120/120),阴性预测值为 40.0%(8/20)。FNAC 检查联合 BRAFV600E 基因检测(0.955)的受试者工作特征曲线下面积高于 FNAC 检查(0.818)和 BRAFV600E 基因检测(0.924)。 结论 超声引导下颈部淋巴结 FNAC 检查联合 BRAFV600E 基因检测提高了甲状腺癌颈部淋巴结转移的诊断效能,值得临床推广。

Objective To investigate the diagnostic significance of fine needle aspiration cytology (FNAC) combined with BRAFV600E gene detection in the diagnosis of cervical lymph node metastasis of thyroid carcinoma. Methods A total of 140 patients of suspected cervical lymph node metastasis were collected as the research objects, and all patients were given ultrasound-guided FNAC and detection of BRAFV600E gene. The significance of the diagnosis was analyzed according to the gold standard after pathological examination. Results All the 140 patients underwent surgical treatment. For FNAC, the sensitivity of FNAC was 63.6% (84/132), the diagnostic specificity was 100% (8/8), the diagnostic accuracy was 65.7% (92/140), the positive predictive value was 100% (84/84), and the negative predictive value was 14.3% (8/56). For detection of BRAFV600E gene, the diagnostic sensitivity was 84.8% (112/132), the diagnostic specificity was 100% (8/8), the diagnostic accuracy was 85.7% (120/140), the positive predictive value was 100% (112/112), and the negative predictive value was 28.5% (8/28). For FNAC combined with BRAFV600E gene detection, the diagnostic sensitivity was 90.9% (120/132), the diagnostic specificity was 100% (8/8), the diagnostic accuracy was 91.4% (128/140), the positive predictive value was 100% (120/120), and the negative predictive value was 40.0% (8/20). The area under curve of receiver operating characteristic for FNAC, detection of BRAFV600E gene, and FNAC combined with BRAFV600E gene detection were 0.818, 0.924, and 0.955 respectively. Conclusion FNAC combined with BRAFV600E gene detection improves the diagnostic accuracy of neck lymph node metastasis in patients with thyroid cancer, which is worthy of performed.

关键词: 甲状腺癌淋巴结转移; 细针穿刺细胞学; BRAFV600E 基因; 诊断价值

Key words: cervical lymph node metastasis of thyroid carcinoma; fine needle aspiration; BRAFV600E gene; diagnostic significance

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1. Sherman SI. Thyroid carcinoma. Lancet, 2003, 361(9356): 501-511.
2. Chung J, Kim EK, Lim H, et al. Optimal indication of thyroglobulin measurement in fine-needle aspiration for detecting lateral metastatic lymph nodes in patients with papillary thyroid carcinoma. Head Neck, 2014, 36(6): 795-801.
3. Giacomini CP, Jeffrey RB, Shin LK. Ultrasonographic evaluation of malignant and normal cervical lymph nodes. Semin Ultrasound CT MR, 2013, 34(3): 236-247.
4. Kim DW, Choo HJ, Lee YJ, et al. Sonographic features of cervical lymph nodes after thyroidectomy for papillary thyroid carcinoma. J Ultrasound Med, 2013, 32(7): 1173-1180.
5. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
6. Bahn RS, Castro MR. Approach to the patient with nontoxic multinodular goiter. J Clin Endocrinol Metab, 2011, 96(5): 1202-1212.
7. Xing M, Alzahrani AS, Carson KA, et al. Association between BRAF V600E mutation and recurrence of papillary thyroid cancer. J Clin Oncol, 2015, 33(1): 42-50.
8. Xing M, Alzahrani AS, Carson KA, et al. Association between BRAF V600E mutation and mortality in patients with papillary thyroid cancer. JAMA, 2013, 309(14): 1493-1501.
9. 黄美玲, 李永平, 凌瑞. BRAF V600E 基因突变与乳头状甲状腺癌淋巴结转移相关性的 Meta 分析. 中国肿瘤, 2017, 26(2): 145-151.
10. Lu J, Gao J, Zhang J, et al. Association between BRAF V600E mutation and regional lymph node metastasis in papillary thyroid carcinoma. Int J Clin Exp Pathol, 2015, 8(1): 793-799.
11. 胡洪生, 孙少华, 沈丰, 等. 以颈部淋巴结转移为首发症状的隐匿性甲状腺癌的诊治探讨. 中国普外基础与临床杂志, 2017, 24(3): 355-360.
12. 陈曦, 陈海珍. 甲状腺癌颈淋巴结转移影像学诊断方法选择及评价. 中国实用外科杂志, 2017, 37(9): 944-948.
13. 刘洁, 胡如英, 张琼敏, 等. 甲状腺乳头状癌术后超声引导下淋巴结穿刺 195 例的临床分析. 医学影像学杂志, 2016, 26(10): 1799-1802.
14. 黄煜庆, 温庆良, 葛明华. 甲状腺乳头状癌术前颈淋巴结转移评估技术研究进展. 肿瘤学杂志, 2017, 23(1): 65-70.
15. 刘晓晖, 华玺, 丁鹏, 等. 超声引导下颈淋巴结穿刺活检对甲状腺癌诊断的临床价值. 实用癌症杂志, 2016, 31(7): 1191-1193.
16. 蒋燕, 郑哲岚. 高频超声及细针穿刺对甲状腺乳头状癌颈部淋巴结转移的诊断意义. 肿瘤, 2015, 35(9): 1034-1038.
17. 章建全, 盛建国, 赵璐璐, 等. 超声引导下正常甲状旁腺细针穿刺物甲状旁腺激素含量测定及细胞学验证. 第二军医大学学报, 2013, 34(4): 357-361.
18. 周好, 陈海珍, 陈曦, 等. 细针穿刺洗脱液测定甲状腺球蛋白鉴别转移淋巴结性质. 外科理论与实践, 2012, 17(1): 17-20.
19. 谭广谋, 廖卫国, 陈伟泉, 等. 颈淋巴结穿刺细胞学检查对甲状腺癌颈淋巴结转移的诊断价值. 广东医学, 2012, 33(2): 248-249.
20. 宫宁, 刘彦强. 超声引导下细针穿刺活检术在颈部增大淋巴结诊断中的应用. 华北国防医药, 2010, 22(2): 134-135.