Wang Yuguo, Wu Xinping, Li Jie, Chen Jing, Tan Huafeng, Sun Liang, Lu Min
Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine Nanjing 210028, China.
Department of General Surgery, Nanjing Lishui District Hospital of Traditional Chinese Medicine Nanjing 211200, China.
Int J Clin Exp Pathol. 2020 Dec 1;13(12):2962-2972. eCollection 2020.
The aims of our study were to explore the preoperative diagnostic value of ultrasound elastography combined with BRAF gene detection in malignant thyroid nodule, and find whether shear wave elastography (SWE) combined with BRAF gene detection can improve the diagnostic sensitivity and specificity.
From 1480 patients with thyroid nodule examined between January 2015 and December 2017, a retrospective analysis was performed on 161 patients who underwent thyroidectomy. Diagnosis was confirmed by postoperative pathology, including 139 malignant thyroid nodules and 22 benign thyroid nodules. All the patients underwent SWE, BRAF gene detection, and the combination for their preoperative evaluation. The sensitivities, specificities, and accuracies of SWE, BRAF gene detection, and the combination for detection of malignant thyroid nodules were calculated and then compared using Fisher's exact probability test, based on the original preoperative reports and postoperative pathology. A receiver-operating characteristic curve analysis was performed to compare the diagnostic performance of SWE, BRAF gene detection, and combination for detecting malignant thyroid nodules.
Based on the original preoperative reports and postoperative pathology, SWE, BRAF gene detection, and the combination showed sensitivities of 88.67%, 78.41%, 92.8%, and specificities of 72.77%, 77.27%, 95.45%. A correct diagnosis was obtained in 85.82%, 78.26%, 93.16% and missed diagnosis rates were 12.23%, 21.58%, and 7.19%. The sensitivities, specificities, and correct diagnosis rate in the combination group were significantly higher than any single detection method (P<0.05). The missed diagnosis rate in the combination group was significantly lower than any single detection method (P<0.05). The receptor operating characteristics curve analysis showed a significantly higher diagnostic performance for the combination than for SWE and BRAF gene detection (P<0.05). The interobserver agreement for detecting malignant thyroid nodule was better for the combination than for SWE or BRAF gene detection alone.
For the detection of a malignant thyroid nodule, SWE combined with BRAF gene detection was more sensitive and showed a higher diagnostic performance than SWE or BRAF gene detection alone.
本研究旨在探讨超声弹性成像联合BRAF基因检测在甲状腺恶性结节中的术前诊断价值，以及剪切波弹性成像（SWE）联合BRAF基因检测能否提高诊断的敏感性和特异性。
对2015年1月至2017年12月间接受检查的1480例甲状腺结节患者进行回顾性分析，选取其中161例行甲状腺切除术的患者。术后病理确诊，其中甲状腺恶性结节139例，甲状腺良性结节22例。所有患者术前均接受SWE、BRAF基因检测及其联合检测进行评估。根据术前原始报告和术后病理，计算SWE、BRAF基因检测及其联合检测甲状腺恶性结节的敏感性、特异性和准确性，然后采用Fisher精确概率检验进行比较。绘制受试者工作特征曲线分析，比较SWE、BRAF基因检测及其联合检测甲状腺恶性结节的诊断性能。
根据术前原始报告和术后病理，SWE、BRAF基因检测及其联合检测的敏感性分别为88.67%、78.41%、92.8%，特异性分别为72.77%、77.27%、95.45%。正确诊断率分别为85.82%、78.26%、93.16%，漏诊率分别为12.23%、21.58%、7.19%。联合检测组的敏感性、特异性和正确诊断率均显著高于任何单一检测方法（P<0.05）。联合检测组的漏诊率显著低于任何单一检测方法（P<0.05）。受试者工作特征曲线分析显示，联合检测的诊断性能显著高于SWE和BRAF基因检测（P<0.05）。联合检测在检测甲状腺恶性结节方面的观察者间一致性优于单独的SWE或BRAF基因检测。
对于甲状腺恶性结节的检测，SWE联合BRAF基因检测比单独的SWE或BRAF基因检测更敏感，诊断性能更高。
