超声引导下细针穿刺细胞学联合BRAF~(V600E)基因检测在甲状腺乳头状癌诊断中的应用价值
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摘要
目的探讨超声引导下细针穿刺细胞学(FNAC)联合丝/苏氨酸特异性激酶突变基因~(V600E)(BRAF~(V600E))检测诊断甲状腺乳头状癌的应用价值。方法选取我院经手术病理证实的甲状腺乳头状癌患者207例,比较FNAC与BRAF~(V600E)单独及联合诊断对其的效能。结果 FNAC诊断甲状腺乳头状癌的敏感性为70.7%,准确率为74.4%;BRAF~(V600E)的敏感性为64.6%,准确率为69.1%。两种方法联合后敏感性为86.2%(156/181),准确率为87.9%(182/207),均较单一检测方法显著提高,差异均有统计学意义(均P<0.001)。结论超声引导下FNAC联合BRAF~(V600E)检测可提高甲状腺乳头状癌的诊断准确率。
Objective To explore the application value of fine-needle aspiration cytology(FNAC)combined with BRAF~(V600E)mutation testing in diagnosis of thyroid papillary cancer(PTC).Methods Two hundred and seven cases of PTC confirmed by operation and pathology were selected. It was compared with the efficacy of FNAC,BRAF~(V600E)alone or in combination.Results Taking pathological results as golden standard,the sensitivity was 70.7% and the accuracy was 74.4%for FNAC in diagnosis of thyroid papillary cancer.The sensitivity of BRAF~(V600E)mutation detection was 64.6%,and the accuracy was 69.1%. The sensitivity(86.2%)and the accuracy(87.9%)for FNAC combined with BRAF~(V600E)mutation testing were significantly higher than single detection method(boht P<0.001).Conclusion FNAC combined with BRAF~(V600E)mutation testing could significantly improve the accuracy of diagnosis of PTC.
Objective To explore the application value of fine-needle aspiration cytology(FNAC)combined with BRAF~(V600E)mutation testing in diagnosis of thyroid papillary cancer(PTC).Methods Two hundred and seven cases of PTC confirmed by operation and pathology were selected. It was compared with the efficacy of FNAC,BRAF~(V600E)alone or in combination.Results Taking pathological results as golden standard,the sensitivity was 70.7% and the accuracy was 74.4%for FNAC in diagnosis of thyroid papillary cancer.The sensitivity of BRAF~(V600E)mutation detection was 64.6%,and the accuracy was 69.1%. The sensitivity(86.2%)and the accuracy(87.9%)for FNAC combined with BRAF~(V600E)mutation testing were significantly higher than single detection method(boht P<0.001).Conclusion FNAC combined with BRAF~(V600E)mutation testing could significantly improve the accuracy of diagnosis of PTC.
引文
[1]中华医学会内分泌学分会,中华医学会外科学分会,中国抗癌协会头颈肿瘤专业委员会,等.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1249-1272.
[2] Gharib H,Papini E,Garber JR,et al. American Association of Clinical Endocrinologists,American College of Endocrinology,and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules—2016 UPDATE[J]. Endocr Pract,2016,22(5):622-639.
[3] Tufano RP,Teixeira GV,Bishop J,et al. BRAF mutation in papillary thyroid cancer and its value in tailoring initial treatment asystematic review and meta-analysis[J]. Medicine(Baltimore),2012,91(5):274-286.
[4] Jinih M,Foley N,Osho O,et al. BRAFV600Emutation as a predictor of thyroid malignancy in indeterminate nodules:a systematic review and meta-analysis[J]. Eur J Surg Oncol,2017,43(7):1219-1227.
[5] Kitahara CM,Sosa JA. The changing incidence of thyroid cancer[J].Nat Rev Endocrinol,2016,12(11):646-653.
[6] ChenW,ZhengR,BaadePD,etal.CancerstatisticsinChina,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[7] Zatelli MC,Trasforini G,Leoni S,et al. BRAF V600E mutation analysis increases diagnostic accuracy for papillary thyroid carcinoma in fine-needle aspiration biopsies[J]. Eur J Endocrinol,2009,161(3):467-473.
[8] Seo JY,Choi JR,Moon HJ,et al. Clinical implication of highly sensitive detection of the BRAFV600E mutation in fine-needle aspirations according to the thyroid bethesda system in patients with conventional papillary thyroid carcinoma[J]. Ann Otol Rhinol Laryngol,2015,124(5):392-399.
[9] Su X,Jiang X,Xu X,et al. Diagnostic value of BRAF(V600E)-mutation analysis in fine-needle aspiration of thyroid nodules:a meta-analysis[J]. Onco Targets Ther,2016,9(1):2495-2509.
[2] Gharib H,Papini E,Garber JR,et al. American Association of Clinical Endocrinologists,American College of Endocrinology,and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules—2016 UPDATE[J]. Endocr Pract,2016,22(5):622-639.
[3] Tufano RP,Teixeira GV,Bishop J,et al. BRAF mutation in papillary thyroid cancer and its value in tailoring initial treatment asystematic review and meta-analysis[J]. Medicine(Baltimore),2012,91(5):274-286.
[4] Jinih M,Foley N,Osho O,et al. BRAFV600Emutation as a predictor of thyroid malignancy in indeterminate nodules:a systematic review and meta-analysis[J]. Eur J Surg Oncol,2017,43(7):1219-1227.
[5] Kitahara CM,Sosa JA. The changing incidence of thyroid cancer[J].Nat Rev Endocrinol,2016,12(11):646-653.
[6] ChenW,ZhengR,BaadePD,etal.CancerstatisticsinChina,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[7] Zatelli MC,Trasforini G,Leoni S,et al. BRAF V600E mutation analysis increases diagnostic accuracy for papillary thyroid carcinoma in fine-needle aspiration biopsies[J]. Eur J Endocrinol,2009,161(3):467-473.
[8] Seo JY,Choi JR,Moon HJ,et al. Clinical implication of highly sensitive detection of the BRAFV600E mutation in fine-needle aspirations according to the thyroid bethesda system in patients with conventional papillary thyroid carcinoma[J]. Ann Otol Rhinol Laryngol,2015,124(5):392-399.
[9] Su X,Jiang X,Xu X,et al. Diagnostic value of BRAF(V600E)-mutation analysis in fine-needle aspiration of thyroid nodules:a meta-analysis[J]. Onco Targets Ther,2016,9(1):2495-2509.