剪切波弹性成像联合BRAF V600E预测甲状腺乳头状癌中央区淋巴结转移的价值

目的探讨剪切波弹性成像（SWE）联合BRAF^V600E预测甲状腺乳头状癌（PTC）中央区淋巴结转移的价值。 方法选取2017年1月至2018年5月浙江大学附属第二医院经手术病理证实为PTC患者217例,共217个结节,所有患者术前均行常规超声检查、SWE、BRAF^V600E检测,术中均行预防性颈部中央区淋巴结清扫。以术后病理结果为"金标准",采用独立样本t检验比较发生中央区淋巴结转移及未发生中央区淋巴结转移两组间的SWE检查的弹性模量值最大值（Emax）、平均值（Emean）及最小值（Emix）值之间的差异;采用χ²检验比较BRAF^V600E突变者与未突变者发生中央区淋巴结转移的差异;绘制受试者工作特征ROC曲线比较SWE各参数及其联合BRAF^V600E预测PTC中央区淋巴结转移的效能。 结果两组间的Emax、Emean、Emin比较,差异均有统计学意义（t=4.49、8.11、3.23,P均<0.01）,且Emean预测效能优于Emax、Emin。BRAF^V600E突变者与未突变者发生中央区淋巴结转移比较,差异有统计学意义（χ²=16.16,P<0.01）。SWE联合BRAF^V600E预测PTC中央区淋巴结转移特异度、准确性、阴性预测值、阳性预测值均高于单独应用SWE及BRAF^V600E,且差异均有统计学意义（χ²=64.769、35.406、22.647、20.247,P均<0.01）。 结论SWE与BRAF^V600E联合应用可以显著提高预测PTC中央区淋巴结转移的特异度、准确性、阴性预测值、阳性预测值。

Value of share wave elastography combined with BRAFV600E in predicting central lymph nodes metastasis of papillary thyroid carcinoma

ObjectiveTo investigate the value of share wave elastography (SWE) combined with BRAF^V600E in predicting central lymph nodes metastasis of papillary thyroid carcinoma (PTC). MethodsThis study collected 217 PTC from 217 patients diagnosed as PTC by surgical pathology,all patients are confirmed by conventional ultrasonography, SWE examination, BRAF ^V600E gene detection and central neck dissection for preventive. Taking postoperative pathological results as gold standard, the independent t test was used to compared the differences in SWE between groups with and without central lymph nodes metastasis; the chi-square test was used to compare the difference of BRAF^V600E between the two groups; and to use the receiver operating characteristic (ROC) curve to investigate the diagnostic efficacy of SWE, BRAF^V600E and their combination in predicting central lymph nodes metastasis of PTC. ResultsThe differences of PTC Emax, Emean, Emin between the two groups showed statistically significant (t=4.49, 8.11, 3.23, all P<0.01), and the predictive value of Emean was higher than Emax、Emin. The difference of BRAF^V600E between the two groups showed statistically significant (χ²=16.16, P<0.01). The specificity, accuracy, negative predictive value and positive predictive value of SWE combined with BRAF^V600E were all higher than single SWE and BRAF^V600E with statistical significant (χ²=64.769, 35.406, 22.647, 20.247, all P<0.01). ConclusionsSWE combined with BRAF^V600E can significantly improve the specificity, accuracy, negative predictive value and positive predictive value in predicting central lymph nodes metastasis of PTC.