常规超声及超声造影对甲状腺微小乳头状癌中突变型的预测价值分析与验证
The analysis and validation of the prediction value of conventional and contrast-enhanced ultrasonography for mutant papillary thyroid microcarcinoma.
作者信息
Li Huilin, Ma Jiaojiao, Xi Xuehua, Tang Jiajia, Wang Linping, Wang Liangkai, Lin Shengtao, Zhang Bo
机构信息
Chinese Academy of Medical Sciences and Graduate School of Peking Union Medical College, Beijing, China.
Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China.
出版信息
Gland Surg. 2022 Oct;11(10):1683-1696. doi: 10.21037/gs-22-493.
BACKGROUND
has certain potential in distinguishing aggressive papillary thyroid microcarcinoma (PTMC). However, it is not recommended to conduct analysis for all suspicious thyroid nodules <1 cm. In order to investigate the ultrasound value indicating BRAF mutation among PTMC, which showed discrepancy in previous studies, we aimed to establish a predictive model based on conventional and contrast-enhanced ultrasonography.
METHODS
We consecutively and retrospectively enrolled patients with PTMC who underwent fine-needle aspiration biopsy (FNAB) at our hospital between January 2020 and January 2021. All PTMC patients received conventional and contrast-enhanced ultrasound prior to FNAB, samples gained went through cytological analysis and BRAF testing subsequently. The following conventional ultrasonography data were analyzed: maximum diameter, echogenicity, echo homogeneity, echogenic foci, location, shape, boundary, aspect ratio, and blood flow volume. Moreover, the following contrast-enhanced ultrasonography data were also analyzed: degree, homogeneity, completeness, and enhancement method. Time-intensity curves from contrast-enhanced ultrasonography were analyzed using VueBox software for different regions of interest, including the entire tumor, the area of strongest enhancement, and healthy thyroid glands. The independent risk factors for mutation in PTMC were identified using univariate and multivariate logistic regression. Their predictive value was tested through internal validation.
RESULTS
Of the 103 PTMC lesions analyzed, 72 involved mutations. Five independent ultrasonographic risk factors for mutation were identified: relative time to peak value in the area of strongest enhancement, unclear boundary, location adjacent to thyroid capsules, maximum diameter >0.5 cm, and punctate echogenic foci. A predictive model based on these factors was able to diagnose mutations in PTMC, with an area under the curve (AUC) of 0.824. During internal validation, this model showed an AUC of 0.723.
CONCLUSIONS
Conventional and contrast-enhanced ultrasound characteristics, including relative time to peak value in the area of strongest enhancement, unclear boundary, location adjacent to thyroid capsules, maximum diameter >0.5 cm, and punctate echogenic foci, may be useful for predicting mutations in patients with PTMC.
背景
在鉴别侵袭性甲状腺微小乳头状癌（PTMC）方面具有一定潜力。然而，不建议对所有直径<1 cm的可疑甲状腺结节进行分析。为了研究PTMC中提示BRAF突变的超声价值（此前研究结果存在差异），我们旨在建立一个基于常规超声和超声造影的预测模型。
方法
我们连续回顾性纳入了2020年1月至2021年1月期间在我院接受细针穿刺活检（FNAB）的PTMC患者。所有PTMC患者在FNAB前均接受了常规超声和超声造影检查，获取的样本随后进行了细胞学分析和BRAF检测。分析了以下常规超声数据：最大直径、回声、回声均匀性、回声灶、位置、形态、边界、纵横比和血流量。此外，还分析了以下超声造影数据：增强程度、均匀性、完整性和增强方式。使用VueBox软件对超声造影的时间-强度曲线进行分析，分析不同感兴趣区域，包括整个肿瘤、强化最强区域和健康甲状腺组织。采用单因素和多因素逻辑回归确定PTMC中BRAF突变的独立危险因素。通过内部验证检验其预测价值。
结果
在分析的103个PTMC病灶中，72个存在BRAF突变。确定了BRAF突变的5个独立超声危险因素：强化最强区域的相对峰值时间、边界不清、毗邻甲状腺包膜的位置、最大直径>0.5 cm和点状回声灶。基于这些因素的预测模型能够诊断PTMC中的BRAF突变，曲线下面积（AUC）为0.824。在内部验证期间，该模型的AUC为0.723。
结论
常规超声和超声造影特征，包括强化最强区域的相对峰值时间、边界不清、毗邻甲状腺包膜的位置、最大直径>0.5 cm和点状回声灶，可能有助于预测PTMC患者的BRAF突变。
Zotero 插件