| 摘要: |
| 目的探讨超声引导下细针抽吸细胞学检查(FNAC，fine-needle aspiration?cytologic) 联合BRAFV600E基因检测对甲状腺微小乳头状癌（PTMC，papillary thyroid microcarcinoma）术前诊断价值。方法对手术病理证实的126例PTMC术前诊疗资料进行回顾性分析，所有结节均行FNAC及细针抽吸提取物BRAFV600E基因突变检测，按结节二维超声最大径≤5mm，5-10mm进行分层，对FNAC结果、基因检测诊断结果与术后病理进行对照分析。 结果≤5mm、5-10mm两组间FNAC诊断准确度分别为58.06%、86.31%，5-10mm组FNAC诊断准确度明显高于≤5mm组，有统计学意义（P＜0.05）；细针抽吸BRAFV600E基因检测突变率为90.32%、92.63%，两组间基因突变率无统计学意义（P＞0.05）；FNAC联合BRAFV600E基因检测对于≤5mm、5-10mm及整体组诊断准确度分别为：93.54%、97.78%、96.82%，两者联合诊断准确度明显高于FNAC，差异有统计学意义(P＜0.05)。部分甲状腺结节难以通过FNAC检查进行诊断（4/126结节良性，22/126结节评估受限），但是联合BRAFV600基因检测后诊断准确度达84.61%，基因诊断技术起到很好的辅助诊断价值。结论 FNAC受甲状腺结节大小影响较大，结节越小（≤5mm），漏诊及误诊病例比例越高；FNAC联合BRAFV600E基因检测对PTMC术前预测值优于单纯FNAC，能显著提高PTMC诊断准确度，两者联合能显著弥补单纯FNAC诊断不足问题,尤其对于FNAC不明确性质结节具有较高临床价值。 |
| 关键词: 超声引导 细针穿刺 甲状腺微小乳头状癌 BRAFV600E 基因 |
| DOI： |
| 投稿时间：2021-03-27修订日期：2021-04-15 |
| 基金项目:重庆市技术创新与应用示范社会民生类一般项目 |
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| Value of ultrasound-guided FNAC combined with BRAFV600E gene detection in preoperative diagnosis of thyroid micropapillary carcinoma |
| hujiayin,chenxiao,helin,chengwei,dupeng,wulinrong,fanjun,zhangzhe,litao |
| () |
| Abstract: |
| Objective to investigate the value of ultrasound-guided fine needle aspiration cytology (FNAC) combined with BRAFV600E gene detection in preoperative diagnosis of thyroid micropapillary carcinoma (PTMC).Methods The preoperative diagnosis and treatment data of 126 cases of PTMC confirmed by surgery and pathology were retrospectively analyzed. FNAC and BRAFV600E gene mutation detection of fine needle suction extract were performed on all nodules.. The nodules were classified according to the maximum diameter of two-dimensional ultrasound ≤5 mm and 5-10 mm, and the FNAC results, genetic test diagnosis results, and postoperative pathology were compared and analyzed.Results the diagnostic accuracy of FNAC between the two groups ≤5mm and 5-10mm was 58.06% and 86.31%, and the accuracy of cytology in the 5-10mm group was significantly higher than that in the ≤5mm group, with statistical significance (P < 0.05). The mutation rates of fine needle aspiration BRAF V600E gene detection were 90.32% and 92.63%, with no statistical significance between the two groups (P > 0.05). The diagnostic accuracy of FNAC combined with BRAFV600E gene detection for ≤ 5 mm, 5 – 10 mm and overall groups was: 93.54%, 97.78%, and 96.82%, and the diagnostic accuracy of the combination of the two was significantly higher than that of FNAC, and the difference was statistically significant(P < 0.05). Some thyroid nodules were difficult to be diagnosed by FNAC（4/126 nodules were misdiagnosed as benign, 22/126 nodules were difficult to diagnose）, but the diagnostic accuracy was 84.61% after combined detection of BRAFV600E gene, and gene diagnosis technology played a good role in auxiliary diagnosis.ConclusionFNAC is greatly affected by the size of thyroid nodule. The smaller the nodule (≤5mm), the higher the proportion of missed diagnosis and misdiagnosis cases. The preoperative predictive value of FNAC combined with BRAFV600E gene test for PTMC is better than that of FNAC alone, which can significantly improve the diagnostic accuracy of PTMC. The combination of FNAC and BRAFV600E can significantly make up for the deficiency of FNAC alone in diagnosis, and has high clinical value especially for nodules with unclear FNAC nature. |
| Key words: Ultrasound guided Fine needle aspiration Thyroid micropapillary carcinoma BRAFV600E gene |
