摘要
目的:探讨超声甲状腺影像报告和数据系统(Thyroid Imaging Report and Data System,TI-RADS)、甲状腺细胞病理学Bethesda报告系统(The Bethesda System for Reporting Thyroid Cytopathology,BSRTC)与BRAF V600E突变分析在甲状腺良恶性结节鉴别诊断中的价值。方法:回顾并分析行手术切除的1093个甲状腺结节的术前超声检查、超声引导下细针穿刺活检(fine-needle aspiration biopsy,FNAB)与BRAF V600E突变分析结果。依据TI-RADS分类标准对结节进行分类,采用BSRTC对结节进行细胞学诊断。分别计算3种方法的灵敏度、特异度及曲线下面积(area under curve,AUC)。结果:单独应用时,TI-RADS诊断甲状腺良恶性结节的灵敏度、阴性预测值和准确度最高,分别为99.21%、84.00%和95.97%;BSRTC诊断阳性预测值和约登指数最高,分别为99.22%和78.52%;BRAF V600E突变分析的AUC最高,为0.893;BRAF V600E突变分析和BSRTC特异度最高,均为91.03%。联合应用时,BSRTC联合BRAF V600E突变分析的诊断特异度、阳性预测值、约登指数、准确度和AUC最高,分别为84.62%、98.77%、79.60%、98.90%和0.898;三者联合诊断的灵敏度、阴性预测值最高,分别为99.61%、91.11%。对于BSRTCⅠ、Ⅲ、Ⅳ类结节,联合TI-RADS、BRAF V600E突变分析可以减少误诊,提高恶性结节检出率。结论:BSRTC、TI-RADS与BRAF V600E突变分析与在甲状腺结节诊断中均有较高的价值,三者联合有助于进一步提高甲状腺结节诊断的准确度,减少误判。
Objective:To explore the value of the Thyroid Imaging Reporting and Data System(TI-RADS),The Bethesda System for Reporting Thyroid Cytopathology(BSRTC)and BRAF V600E mutation analysis in the differential diagnosis of thyroid nodules.Methods:The preoperative ultrasonography,ultrasound-guided fine-needle aspiration biopsy(FNAB),and BRAF V600E mutation analysis results of 1093 thyroid nodules that underwent surgery resection were analyzed.TI-RADS classification criteria was used to classify the nodules,and BSRTC was used to undergo cytological diagnosis of the nodules.The sensitivity,specificity,and area under curve(AUC)of the three methods were calculated and compared.Results:When applied individually,the sensitivity,negative predictive value,and accuracy of TI-RADS were the highest among the three methods,and they were 99.21%,84.00%,and 95.97%,respectively.BSRTC had the highest positive predictive value,Youden index,and the values were 99.22%,and 78.52%,respectively.BRAF V600E mutation analysis had the highest AUC(0.893).Both BRAF V600E mutation analysis and BSRTC had the highest specialty(91.93%).When applied in combination,the combination of BSRTC and BRAF V600E mutation analysis had the highest specialty(84.62%),positive predictive value(98.77%),Youden index(79.60%),accuracy(98.90%)and AUC(0.898).The highest sensitivity(99.61%),and negative predictive value(91.11%)were achieved when all three methods were combined.For theⅠ,Ⅲ,andⅣnodules,BSRTC combined with TI-RADS and/or BRAF V600E mutation analysis reduced misdiagnosis and improved diagnostic accuracy.For theⅠ,Ⅲ,andⅣnodules,BSRTC combined with TI-RADS and BRAF V600E mutation analysis reduced misdiagnosis and improved diagnostic accuracy.Conclusion:BSRTC,TI-RADS,and BRAF V600E mutation analysis all have high value in the diagnosis of thyroid nodules,and the combination of three methods could improve diagnostic efficiency and reduce misdiagnosis.
作者
姬祥鹏
郭曼
闻宝杰
张捷
金志斌
于鹏丽
吴敏
孔文韬
JI Xiangpeng;GUO Man;WEN Baojie;ZHANG Jie;JIN Zhibin;YU Pengli;WU Min;KONG Wentao(Nanjing Drum Tower Hospital Clinical College of Jiangsu University,Nanjing 210009,Jiangsu Province,China;Department of Ultrasonic Diagnosis,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210009,Jiangsu Province,China;Department of Ultrasonic Diagnosis,The Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210009,Jiangsu Province,China)
出处
《肿瘤影像学》
2023年第2期156-162,共7页
Oncoradiology
基金
南京市卫生青年人才培养工程(QRX17011)。
作者简介
通信作者:孔文韬,E-mail:Breezewen@163.com。
