甲状腺乳头状癌中超声造影和BRAF V600E的特征
The features of contrast enhanced ultrasound and BRAF V600E in papillary thyroid carcinoma.
作者信息
Lin Zi-Mei, Yan Cao-Xin, Song Yue, Hong Yu-Rong, Wen Qing, Xu Yong-Yuan, Pan Min-Qiang, Ye Qin, Huang Pin-Tong
机构信息
Department of Ultrasound in Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, China.
Department of Pathology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, China.
出版信息
J Thorac Dis. 2019 Dec;11(12):5071-5078. doi: 10.21037/jtd.2019.11.78.
BACKGROUND
BRAF V600E mutation was proved to be associated with thyroid cancer. Papillary thyroid carcinoma (PTC) with positive BRAF mutation might have a more aggressive behavior. We investigated the correlation of the contrast-enhanced ultrasound (CEUS) features with BRAF 600VE in PTC.
METHODS
The medical records of 1,199 patients with 1,315 nodules who underwent CEUS prior to fine needle aspiration (FNA) from January 2016 to March 2018 were retrospectively reviewed. The features of their enhancement were assessed from eight aspects: degree of enhancement, method of enhancement, homogeneity of enhancement, completeness of enhancement, boundary of the enhanced lesions, shape of the enhanced lesions, size of the enhanced lesions, and wash out period of the enhanced lesions. The patients then examined for the BRAF V600E mutation using specimens obtained from FNA.
RESULTS
BRAF mutations were found in 888 of 1,315 nodules. The CEUS features were significantly different between BRAF-positive and BRAF-negative nodules. The BRAF mutation positive nodules were more often with larger size, hypo-enhancement, centripetal enhancement, inhomogeneous enhancement, complete enhancement, blurred boundary, irregular shape, and with wash out period at preoperative CEUS than those without BRAF mutations (P<0.001). However, no significant correlation was showed in Spearman's rank correlation between the CEUS features and BRAF mutation, except for degree of enhancement, method pattern of enhancement, and completeness of complete enhancement. Multivariate analysis showed that centripetal (OR: 1.465, 95% CI: 1.129-1.903) and no significant enhancement (OR: 0.790, 95% CI: 0.639-0.977) were predictive for the presence of BRAF mutations. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of no significant enhancement and centripetal enhancement of CEUS for predicting BRAF mutation were 68.3%, 40.0%, 91.6%, 11.7%, and 72.4%, 35.1%, 37.8%, 70.0%, respectively.
CONCLUSIONS
Our study indicated that preoperative thyroid nodule characteristics on CEUS might serve as a useful tool to BRAF mutation in PTC.
背景
BRAF V600E突变被证实与甲状腺癌相关。BRAF突变阳性的甲状腺乳头状癌（PTC）可能具有更具侵袭性的行为。我们研究了PTC中对比增强超声（CEUS）特征与BRAF 600VE的相关性。
方法
回顾性分析2016年1月至2018年3月期间1199例患者1315个结节在细针穿刺活检（FNA）前接受CEUS检查的病历。从增强程度、增强方式、增强均匀性、增强完整性、增强病变边界、增强病变形状、增强病变大小和增强病变消退期八个方面评估其增强特征。然后使用FNA获取的标本对患者进行BRAF V600E突变检测。
结果
1315个结节中有888个发现BRAF突变。BRAF阳性和BRAF阴性结节的CEUS特征存在显著差异。BRAF突变阳性结节在术前CEUS上比无BRAF突变的结节更常表现为更大尺寸、低增强、向心性增强、不均匀增强、完全增强、边界模糊、形状不规则以及有消退期（P<0.001）。然而，除增强程度、增强方式和完全增强的完整性外，CEUS特征与BRAF突变之间在Spearman等级相关性分析中未显示出显著相关性。多因素分析表明，向心性增强（OR：1.465，95%CI：1.129 - 1.903）和无明显增强（OR：0.790，95%CI：0.639 - 0.977）可预测BRAF突变的存在。CEUS无明显增强和向心性增强预测BRAF突变的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为68.3%、40.0%、91.6%、11.7%和72.4%、35.1%、37.8%、70.0%。
结论
我们的研究表明，术前CEUS显示的甲状腺结节特征可能是预测PTC中BRAF突变的有用工具。
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