用于诊断甲状腺结节的新型实用评分系统

Novel and Practical Scoring Systems for the Diagnosis of Thyroid Nodules.

作者信息

Wei Ying, Zhou Xinrong, Liu Siyue, Wang Hong, Liu Limin, Liu Renze, Kang Jinsong, Hong Kai, Wang Daowen, Yuan Gang

机构信息

Department of Internal Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Molecular Diagnostic Laboratory, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China.

出版信息

PLoS One. 2016 Sep 21;11(9):e0163039. doi: 10.1371/journal.pone.0163039. eCollection 2016.

DOI:10.1371/journal.pone.0163039

PMID:27654865

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5031406/

Abstract

OBJECTIVE

The clinical management of patients with thyroid nodules that are biopsied by fine-needle aspiration cytology and yield indeterminate results remains unsettled. The BRAF V600E mutation has dubious diagnostic value due to its low sensitivity. Novel strategies are urgently needed to distinguish thyroid malignancies from thyroid nodules.

DESIGN

This prospective study included 504 thyroid nodules diagnosed by ultrasonography from 468 patients, and fine-needle aspiration cytology was performed under ultrasound guidance. Cytology and molecular analysis, including BRAF V600E, RET/PTC1 and RET/PTC3, were conducted simultaneously. The cytology, ultrasonography results, and mutational status were gathered and analyzed together. Predictive scoring systems were designed using a combination of diagnostic parameters for ultrasonography, cytology and genetic analysis. The utility of the scoring systems was analyzed and compared to detection using the individual methods alone or combined.

RESULT

The sensitivity of scoring systema (ultrasonography, cytology, BRAF V600E, RET/PTC) was nearly identical to that of scoring systemb (ultrasonography, cytology, BRAF V600E); these were 91.0% and 90.2%, respectively. These sensitivities were significantly higher than those obtained using FNAC, genetic analysis and US alone or combined; their sensitivities were 63.9%, 70.7% and 87.2%, respectively. Scoring systemc (ultrasonography, cytology) was slightly inferior to the former two scoring systems but still had relatively high sensitivity and specificity (80.5% and 95.1%, respectively), which were significantly superior to those of single cytology, ultrasonography or genetic analysis. In nodules with uncertainty cytology, scoring systema, scoring systemb and scoring systemc could elevate the malignancy detection rates to 69.7%, 69.7% and 63.6%, respectively.

CONCLUSION

These three scoring systems were quick for clinicians to master and could provide quantified information to predict the probability of malignant nodules. Scoring systemb is recommended for improving the detection rate among nodules of uncertain cytology.

摘要

目的

对于经细针穿刺活检细胞学检查结果不确定的甲状腺结节患者，其临床管理仍未确定。BRAF V600E突变由于其低敏感性，诊断价值存疑。迫切需要新的策略来区分甲状腺恶性肿瘤和甲状腺结节。

设计

这项前瞻性研究纳入了468例患者经超声诊断的504个甲状腺结节，并在超声引导下进行细针穿刺活检细胞学检查。同时进行细胞学和分子分析，包括BRAF V600E、RET/PTC1和RET/PTC3。收集并综合分析细胞学、超声检查结果及突变状态。使用超声检查、细胞学和基因分析的诊断参数组合设计预测评分系统。分析评分系统的效用，并与单独使用或联合使用个体方法的检测结果进行比较。

结果

评分系统a（超声检查、细胞学、BRAF V600E、RET/PTC）的敏感性与评分系统b（超声检查、细胞学、BRAF V600E）几乎相同，分别为91.0%和90.2%。这些敏感性显著高于单独使用或联合使用细针穿刺活检、基因分析和超声检查所获得的敏感性，后者的敏感性分别为63.9%、70.7%和87.2%。评分系统c（超声检查、细胞学）略逊于前两个评分系统，但仍具有相对较高的敏感性和特异性（分别为80.5%和95.1%），显著优于单一的细胞学、超声检查或基因分析。在细胞学结果不确定的结节中，评分系统a、评分系统b和评分系统c可将恶性肿瘤检出率分别提高至69.7%、69.7%和63.6%。