Kwak TI-RADS分类联合BRAF^V600E基因突变检测对不确定意义细胞学诊断结果的甲状腺结节的诊断价值

目的探讨Kwak TI-RADS分类联合BRAF^V600E基因突变检测诊断不确定意义细胞学诊断结果的甲状腺结节良恶性的应用价值。方法选取于我院行细针穿刺细胞学诊断且结果为不确定意义的76例甲状腺结节患者,均行常规超声和BRAF^V600E基因突变检测,以手术病理结果或临床随访为标准,绘制受试者工作特征(ROC)曲线,计算并比较Kwak TI-RADS分类与BRAF^V600E基因突变检测鉴别不确定意义细胞学诊断结果的甲状腺结节良恶性的诊断效能。结果纳入的76例甲状腺结节均经手术病理或临床随访证实,包括恶性结节50例,良性结节26例。Kwak TI-RADS分类诊断甲状腺恶性结节的敏感性78.0%,特异性76.9%,准确率77.6%,曲线下面积0.775;BRAF^V600E基因突变检测的诊断敏感性62.0%,特异性100%,准确率75.0%,曲线下面积0.810;二者联合诊断的敏感性88.0%,特异性84.6%,准确率86.8%,曲线下面积0.873,与两者单独应用比较,差异均无统计学意义。结论Kwak TI-RADS分类联合BRAF^V600E基因突变检测可以一定程度上提高对不确定意义细胞学诊断结果的甲状腺结节良恶性的诊断效能,有一定的临床价值。

Application value of Kwak TI-RADS and BRAF^V600E gene mutation detection in thyroid nodules with indeterminate cytological results

Objective To evaluate the diagnostic value of Kwak TI-RADS and BRAFV600E gene mutation detection for indeterminate thyroid nodules.Methods A total of 76 patients with 76 thyroid nodules were selected,which were initially diagnosed as indeterminate thyroids nodules,who were underwent ultrasound and BRAFV600E gene mutation detection.The receiver operating characteristic(ROC)curve based on the surgical pathological results or clinical follow-up was drawn,and the diagnostic efficacy of Kwak TI-RADS classification and BRAFV600E gene mutation detection in differentiating benign and malignant thyroid nodules with uncertain cytological results was calculated and compared.Results Seventy-six cases of thyroid nodules were confirmed by surgical pathology or clinical follow-up,including 50 cases of malignant nodules and 26 cases of benign nodules.The sensitivity,specificity,accuracy and area under the curve of BRAFV600E gene mutation were 62.0%,100%,75.0%,and 0.810,respectively,of which Kwak TI-RADS were 78.0%,76.9%,77.6%and 0.775,respectively,and of which Kwak TI-RADS combined with BRAFV600E gene mutation detection were 88.0%,84.6%,86.8%,0.873,respectively.The sensitivity,specificity and accuracy of the combined application of Kwak Ti-RADS and BRAFV600E gene mutation detection were not statistically significant compared with the two applications alone.Conclusion For indeterminate thyroid nodules with indeterminate cytological results,Kwak TI-RADS combined with BRAFV600E gene mutation detection can certainly improve its diagnostic efficacy.