细针穿刺细胞学联合BRAFV600E基因突变检测在老年甲状腺结节患者中的诊断价值

摘要

目的 探讨细针穿刺细胞(FNAC)检查联合BRAFV600E基因突变检测在老年甲状腺结节患者中的诊断价值.方法 前瞻性队列研究,收集我院2017年1-12月因甲状腺结节就诊且超声提示可疑恶性的老年患者168例,彩色多普勒超声检查所见结节数目为185个,术前均行FNAC和BRAFV600E基因突变检测,与术后病理结果进行比较,分析FNAC、BRAFV600E基因突变检测及两者联合检测的诊断价值.结果 185个甲状腺结节病理学检查显示146个恶性病变(137个乳头状癌,滤泡状癌9个),39个良性病变(结节性甲状腺肿31个,桥本氏甲状腺炎5个,腺瘤3个);FNAC的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为79.5％、59.0％、75.1％、75.2％、45.6％;BRAFV600E基因突变检测的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为78.1％、51.3％、72.4％、84.4％、51.2％;联合检测的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为93.4％、77.5％、86.2％、90.8％、53.4％,联合检测的敏感性、特异性、准确性、阳性预测值、阴性预测值高于单独检测(均P＜0.05).结论 对FNAC无法确诊的甲状腺结节,辅助BRAFV600E基因突变检测,可提高检测的敏感性、特异性和准确性,有助于结节的良、恶性鉴别.%Objective To investigate the diagnostic value of fine needle aspiration biopsy combined with BRAFV600E gene mutation detection in elderly patients with thyroid nodules.Methods A total of 168 elderly patients with thyroid nodules suspicious for malignancy on ultrasound from January 2017 to December 2017 at our hospital were enrolled in this study.Using color Doppler ultrasound,185 thyroid nodules were found.Fine needle aspiration cytology(FNAC)and BRAFV600E gene mutation detection were performed before surgery and the findings were compared with postoperative pathological results.The diagnostic value of single and combined detection of FNAC and BRAFV600E gene mutation was evaluated.Results Among 185 thyroid nodules,there were 146 malignant lesions including 137 papillary carcinomas and 9 follicular carcinomas,and 39 benign lesions including 31 cases of nodular goiter,5 cases of Hashimoto's thyroiditis and 3 cases of adenoma.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of FNAC were 79.5％,59.0％,75.1％,75.2％,and 45.6％,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of BRAFV600E gene mutation detection were 78.1％,51.3 ％,72.4 ％,84.4 ％ and 51.2 ％,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the combined detection were 93.4％,77.5％,86.2％,90.8％ and 53.4％,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the combined detection were higher than those of either method used alone (all P＜0.05).Conclusions For some thyroid nodules that cannot be unequivocally diagnosed as benign or malignant by FNAC,the combined detection of FNAC and BRAFV600E gene mutation can significantly improve the sensitivity,specificity and accuracy of malignancy detection,differentiate between benign and malignant nodules,and help formulate operation plans and subsequent treatment.