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超声引导下细针穿刺联合BRAF检测与甲状腺乳头状癌侵袭性病理特征的相关性

[Correlation between Ultrasound-guided Fine-needle Aspiration Combined with BRAF Detection and Invasive Pathological Features of Papillary Thyroid Cancer].

作者信息

Zhang Ying, Luo Yu Kun, Zhang Yan, Zhang Ming Bo, Guang Yang, Xie Fang, Jiang Bo, Tang Jie

机构信息

School of Medicine,Nankai University,Tianjin 300071,China.

Department of Ultrasound,Chinese PLA General Hospital,Beijing 100853,China.

出版信息

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2019 Aug 30;41(4):517-523. doi: 10.3881/j.issn.1000-503X.10995.

Abstract

To analyze the potential associations of ultrasound-guided fine-needle aspiration(FNA),BRAF gene mutation detection,and the combination of these two techniques with the clinicopathological features of papillary thyroid cancer(PTC). Methods Patients with PTC confirmed by surgery from April 2016 to July 2017 were included in this study.The relationship between clinicopathological features and BRAF mutation,FNA results,and the combination of them were explored. Results The sensitivity of FNA was 86.3%(227/263)and the mutation rate of BRAF was 85.9%(226/263)in 263 patients with PTC.The mutation rate of papillary thyroid microcarcinoma(PTMC)was 91.1%(153/168)and that of non-PTMC was 76.8%(73/95).A total of 225 patients underwent lymph node dissection.The lymph node metastasis rate was 35.6%(80/225),and it was 23.8%(34/143)in PTMC,56.1%(46/82)in non-PTMC;in addition,9.9%(26/263)of PTC patients had extracapsular invasion.BRAF mutation rate was higher in patients with the following features:aged over 45 years(=0.043);the tumor was FNA diagnosed as malignant or suspected malignant(=0.011);the tumor had a maximum diameter of ≤1 cm(=0.001);and the primary tumor was in stage T(=0.039);however,there was no significant difference in BRAF mutation rate among patients with different sex,capsule invasion,or lymph node metastasis.The diagnostic sensitivity of FNA was not statistically different under different clinical and pathological characteristics.The clinicopathologic features of FNA and BRAF double-positive patients were not significantly different from those of other patients. Conclusion FNA-confirmed malignancy,BRAF gene mutation,and their double-positive results are not correlated with the invasive pathological features of PTC,and thus their roles in guiding an extended operation(or not)are limited.

摘要

分析超声引导下细针穿刺抽吸活检(FNA)、BRAF基因突变检测以及这两种技术的联合应用与甲状腺乳头状癌(PTC)临床病理特征之间的潜在关联。方法纳入2016年4月至2017年7月手术确诊的PTC患者。探讨临床病理特征与BRAF基因突变、FNA结果及其联合应用之间的关系。结果263例PTC患者中,FNA的敏感性为86.3%(227/263),BRAF基因突变率为85.9%(226/263)。甲状腺微小乳头状癌(PTMC)的突变率为91.1%(153/168),非PTMC的突变率为76.8%(73/95)。共有225例患者接受了淋巴结清扫。淋巴结转移率为35.6%(80/225),PTMC中为23.8%(34/143),非PTMC中为56.1%(46/82);此外,9.9%(26/263)的PTC患者有包膜外侵犯。具有以下特征的患者BRAF基因突变率较高:年龄超过45岁(P=0.043);肿瘤FNA诊断为恶性或疑似恶性(P=0.011);肿瘤最大直径≤1cm(P=0.001);原发肿瘤处于T分期(P=0.039);然而,不同性别、包膜侵犯或淋巴结转移患者的BRAF基因突变率无显著差异。不同临床病理特征下FNA的诊断敏感性无统计学差异。FNA和BRAF双阳性患者的临床病理特征与其他患者无显著差异。结论FNA确诊为恶性、BRAF基因突变及其双阳性结果与PTC的侵袭性病理特征无关,因此它们在指导(或不指导)扩大手术方面的作用有限。

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