超声联合血清学及BRAF基因检测对鉴别TI-RADS 4类甲状腺结节良恶性的诊断价值评价

doi:10.3969/j.issn.1004-583X.2022.04.010

摘要/Abstract

摘要：

目的探讨超声、血清学和BRAF基因检测3种检查方法单独以及联合应用时,对鉴别根据甲状腺影像报告和数据系统(Thyroid Imaging Reporting and Data System, TI-RADS)中已经被报告为TI-RADS 4类结节良恶性的诊断价值。方法回顾性分析经锦州医科大学附属第一医院超声医学科检查报告为TI-RADS 4类结节的102例患者,并对这102例患者均进行血清学及BRAF基因检测。根据手术病理及穿刺病理结果将患者分为良性组和恶性组,评估使用不同诊断方法对鉴别甲状腺TI-RADS 4类结节良恶性的诊断效能。结果超声检查结果提示恶性组的图像表现为低回声、内部存在钙化、边界模糊、形态不规则的患者数目多于良性组(P<0.05);恶性组促甲状腺素(TSH)的检验值高于良性组(P<0.05);恶性组BRAF基因产生突变的占比明显多于良性组(P<0.05)。联合使用超声、血清学及BRAF基因检测3种检查技术的准确度(98.04%)、灵敏度(97.22%)、特异度(100.00%)及诊断效能(0.926)均高于应用一种检查技术(P<0.05)。结论联合应用超声、血清学及BRAF基因检测方法对于鉴别TI-RADS 4类甲状腺结节的良恶性更具有临床价值。

关键词: 超声, 血清学检查, BRAF基因, 甲状腺结节, 甲状腺影像报告和数据系统

Abstract:

Objective To explore the diagnostic value of ultrasound with serology and BRAF testing in the identification of benign and malignant thyroid imaging reporting and data system (TI-RADS) category 4 nodules.Methods The data of 102 patients with TI-RADS category 4 nodules form department of ultrasound, the First Affiliated Hospital of Jinzhou Medical University were retrospectively analyzed, and serological and BRAF gene tests were performed in all of them. Patients were divided into benign group and malignant group according to surgical and pathologic findings, the different diagnostic efficacy in differentiating benign and malignant TI-RADS category 4 nodules was evaluated.Results TI-RADS indicated the numbers of hypoechoic rim with internal calcification, blurred boundary, irregular shape of patients with malignant nodules was more than those of patients with benign nodules (P<0.05). The higher thyroid-stimulating hormone (TSH) value of patients with malignant nodules was common (P<0.05). The numbers of BRAF gene mutation of patients with malignant nodules were significantly higher than those of patients with benign nodules (P<0.05). The accuracy (98.04%), sensitivity (97.22%), specificity (100.00%) and diagnostic efficiency (0.926) of ultrasonography, serology and BRAF testing were higher than any of the three alone check (P<0.05).Conclusion The combined of the above three has more clinical value in the identification of benign and malignant TI-RADS category 4 nodules.

Key words: ultrasonic, serological examination, BRAF gene, thyroid nodule, TI-RADS

中图分类号:

R581

胡钰晗, 陈菲. 超声联合血清学及BRAF基因检测对鉴别TI-RADS 4类甲状腺结节良恶性的诊断价值评价[J]. 临床荟萃, 2022, 37(4): 339-342.

Hu Yuhan, Chen Fei. Diagnostic value of ultrasound with serology and BRAF testing in the identification of benign and malignant TI-RADS category 4 nodules[J]. Clinical Focus, 2022, 37(4): 339-342.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.04.010

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I4/339

图/表 7

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超声影像特点	良性(n=30)	恶性(n=72)	χ²值	P值
单发/多发
单发多发	9(30.00) 21(70.00)	21(29.17) 51(70.83)	0.007	0.933
回声情况
低回声高回声	6(20.00) 24(80.00)	60(83.33) 12(16.67)	37.194	0.000
钙化
有无	5(16.67) 25(83.33)	53(73.61) 19(26.39)	27.995	0.000
边界
清晰模糊	25(83.33) 5(16.67)	9(12.50) 63(87.50)	47.813	0.000
形态
规则模糊	20(66.67) 10(33.33)	6(8.33) 66(91.67)	37.940	0.000

超声影像特点	良性(n=30)	恶性(n=72)	χ²值	P值
单发/多发
单发多发	9(30.00) 21(70.00)	21(29.17) 51(70.83)	0.007	0.933
回声情况
低回声高回声	6(20.00) 24(80.00)	60(83.33) 12(16.67)	37.194	0.000
钙化
有无	5(16.67) 25(83.33)	53(73.61) 19(26.39)	27.995	0.000
边界
清晰模糊	25(83.33) 5(16.67)	9(12.50) 63(87.50)	47.813	0.000
形态
规则模糊	20(66.67) 10(33.33)	6(8.33) 66(91.67)	37.940	0.000

组别	例数	FT3 (pmol/L)	FT4 (pmol/L)	TSH (μIU/ml)
良性组	30	4.94±0.47	13.92±1.45	3.75±1.33
恶性组	72	4.68±0.72	13.48±1.96	5.03±0.81
t值		1.503	1.116	5.984
P值		0.136	0.267	0.000

组别	例数	FT3 (pmol/L)	FT4 (pmol/L)	TSH (μIU/ml)
良性组	30	4.94±0.47	13.92±1.45	3.75±1.33
恶性组	72	4.68±0.72	13.48±1.96	5.03±0.81
t值		1.503	1.116	5.984
P值		0.136	0.267	0.000

组别	例数	BRAF基因
组别	例数	未发生突变	发生突变
良性组	30	29(96.7)	1(3.0)
恶性组	72	21(29.2)	51(70.8)
χ²值		35.955
P值		0.000