穿刺手感联合BRAF V600E突变在贝塞斯达Ⅲ类甲状腺结节重复细针穿刺活检中的诊断价值
Diagnostic value of puncture feeling combined with BRAF V600E mutation in repeat US-FNA biopsy of Bethesda III thyroid nodules.
作者信息
Li Li, Li Peipei, Chen Xiao, Kang Lin, Ye Yuquan
机构信息
School of Graduate, Hebei Medical University, Shijiazhuang, China.
Department of Ultrasound, Hebei General Hospital, Shijiazhuang, China.
出版信息
Gland Surg. 2021 Jun;10(6):2019-2027. doi: 10.21037/gs-21-302.
BACKGROUND
The diagnosis and treatment of Bethesda III thyroid nodules has always been controversial. Our aim is to study the value of puncture feeling combined with BRAF V600E mutation detection in the diagnosis of Bethesda III thyroid nodules in repeat fine needle aspiration (FNA).
METHODS
From January 1, 2017 to December 31, 2021, a total of 1,114 thyroid nodules were included, of which Bethesda III thyroid nodules accounted for 12.1%. We analyzed the correlation between puncture feeling and postoperative pathology. Then, the diagnostic value of puncture feeling in Bethesda III thyroid nodules and the mutation rate of BRAF V600E in repeated FNA and its correlation with puncture feeling were analyzed.
RESULTS
The results showed that there was a significant correlation between puncture feeling and postoperative pathology in the 1114 thyroid nodules (P<0.001). Additionally, 93.4% (299/320) of the thyroid nodules with soft puncture feeling were benign, 89.0% (460/517) of the thyroid nodules with hard puncture feeling were malignant, and 93.1% (258/277) of the thyroid nodules with a puncture feeling of hard with grittiness were malignant. There was high consistency of puncture feelings among different operators (P<0.001). The distribution of puncture feeling between benign and malignant thyroid nodules was significantly different (P<0.001) in Bethesda III thyroid nodules. In the puncture feeling ROC curve of Bethesda III thyroid nodules based on pathology, the AUC was 0.895 (95% CI: 0.817-0.973, P<0.001). In repeat FNA, BRAF V600E was significantly correlated with puncture feeling (P<0.001). BRAF V600E mutation was found in 22 (68.8%) malignant nodules.
CONCLUSIONS
Puncture feelings of hard and hard with grittiness were malignant risk factors. Repeated FNA and BRAF V600 mutation detection should be performed for Bethesda III thyroid nodules with a hard or hard with grittiness puncture feeling.
背景
贝塞斯达Ⅲ类甲状腺结节的诊断与治疗一直存在争议。我们的目的是研究穿刺手感联合BRAF V600E突变检测在重复细针穿刺抽吸（FNA）诊断贝塞斯达Ⅲ类甲状腺结节中的价值。
方法
纳入2017年1月1日至2021年12月31日期间的1114个甲状腺结节，其中贝塞斯达Ⅲ类甲状腺结节占12.1%。我们分析了穿刺手感与术后病理的相关性。然后，分析了穿刺手感在贝塞斯达Ⅲ类甲状腺结节中的诊断价值、重复FNA中BRAF V600E的突变率及其与穿刺手感的相关性。
结果
结果显示，1114个甲状腺结节的穿刺手感与术后病理之间存在显著相关性（P<0.001）。此外，穿刺手感柔软的甲状腺结节中93.4%（299/320）为良性，穿刺手感硬的甲状腺结节中89.0%（460/517）为恶性，穿刺手感硬且有砂砾感的甲状腺结节中93.1%（258/277）为恶性。不同操作者之间的穿刺手感一致性较高（P<0.001）。在贝塞斯达Ⅲ类甲状腺结节中，良性和恶性甲状腺结节之间的穿刺手感分布有显著差异（P<0.001）。在基于病理的贝塞斯达Ⅲ类甲状腺结节穿刺手感ROC曲线中，AUC为0.895（95%CI：0.817-0.973，P<0.001）。在重复FNA中，BRAF V600E与穿刺手感显著相关（P<0.001）。在22个（68.8%）恶性结节中发现了BRAF V600E突变。
结论
穿刺手感硬和硬且有砂砾感是恶性风险因素。对于穿刺手感硬或硬且有砂砾感的贝塞斯达Ⅲ类甲状腺结节，应进行重复FNA和BRAF V600突变检测。
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