摘要
目的探讨临床病理特征和Braf基因检测在术前细针穿刺细胞学诊断不明确的甲状腺乳头状癌的相关风险。方法选取2017年1月-2020年8月首次收入重庆医科大学附属第一医院穿刺病理诊断不明确的患者962例,所有患者均已完善术前相关检查并于我院行甲状腺手术治疗,回顾性分析临床特征和Braf基因检测与乳头状癌相关性,使用单因素分析及二元Logistic回归分析确定独立危险因素并预测结果。结果在962例患者中,Braf基因突变型(突变率为89.50%)与PTC存在显著相关(OR=22.564,95%CI:10.125~50.285,P=0.000)。此外TI-RADS分类为4B类及以上(OR=1.633,95%CI:1.019~2.616,P=0.041),结节<1 cm(OR=0.420,95%CI:0.279~0.634,P=0.000)的患者术后病检为PTC的比例更高。在预测颈部淋巴结转移的情况中,Braf基因突变型(OR=2.126,95%CI:1.316~3.432,P=0.002)、男性患者(OR=2.102,95%CI:1.532~2.884,P=0.000)、结节>1 cm(OR=1.581,95%CI:1.218~2.054,P=0.001)、TI-RADS分类为4B类及以上(OR=1.368,95%CI:1.186~1.578,P=0.000)其术后病检淋巴结转移比例和风险更高。而年龄>45岁(OR=0.741,95%CI:0.649~0.846,P=0.000)是PTC淋巴结转移的保护性因素。结论在术前穿刺诊断不明确的患者中,Braf基因突变可以作为PTC的辅助诊断工具,Braf基因检测联合FNAC诊断可增加术前诊断的精确性,减少漏诊率。Braf基因突变型、TI-RADS分类4B类及以上及结节大小<1 cm可以作为预测PTC的独立危险因素。结合Braf基因突变型、患者男性、年龄<45岁、TI-RADS分类为4B类及以上及结节大小>1 cm可作为预测PTC淋巴结转移(LNM)的独立预测因子。
Objective To investigate the risk of clinicopathological features and Braf gene detection in papillary thyroid carcinoma with undefinable preoperative fine needle aspiration cytology.Methods The clinicopathological data of 962 undefinable preoperative diagnosed patients were included from January 2017 to August 2020 in the First Affiliated Hospital of Chongqing Medical University.All patients had completed preoperative examination and underwent thyroid surgery in our hospital.The clinical characteristics and the correlation between Braf gene detection and papillary carcinoma were retrospectively analyzed.Univariate analysis and binary logistic regression analysis were used to determine independent risk factors and predict results.Results In 962 patients,Braf gene mutation(mutation rate was 89.50%)was significantly associated with PTC(OR=22.564,95%CI:10.125-50.285,P=0.000).In addition,the proportion of PTC was higher in patients with TI-RADS classification was 4B and above(OR=1.633,95%CI:1.019-2.616,P=0.041)and nodules<1 cm(OR=0.420,95%CI:0.279-0.634,P=0.000).In the prediction of cervical lymph node metastasis,the proportion and risk of postoperative pathological lymph node metastasis were higher in BRAF gene mutation type(OR=2.126,95%CI:1.316-3.432,P=0.002),male patients(OR=2.102,95%CI:1.532-2.884,P=0.000),nodules>1 cm(OR=1.581,95%CI:1.218-2.054,P=0.001),and TI-RADS classification of 4B and above(OR=1.368,95%CI:1.186-1.578,P=0.000).While,Age>45 years old(OR=0.741,95%CI:0.649-0.846,P=0.000)was a protective factor for lymph node metastasis in PTC.Conclusion In patients with undefinable preoperative diagnosis,Braf gene mutation can be used as a tool to assist in the diagnosis of thyroid papillary carcinoma.Braf gene detection combined with FNAC diagnosis can increase the accuracy of preoperative diagnosis and reduce the rate of missed diagnosis.Braf gene mutation type,TI-RADS classification 4B and above,and nodule size<1 cm can be used as independent risk factors for predicting PTC.Combined with Braf gene mutation type,male patient,age<45 years old,TI-RADS classification of 4B and above and nodule size>1 cm,it can be used as an independent predictor of lymph node metastasis(LNM)in PTC.
作者
李雪松
苏新良
陶冬梅
LI Xue-song;SU Xin-liang;TAO Dong-mei(Department of Endocrine and Breast Surgery,the First Affiliated Hospital of Chongqing Medica University,Chongqing 400016,China)
出处
《医学信息》
2024年第4期119-123,共5页
Journal of Medical Information
作者简介
李雪松(1993.2-),男,重庆人,硕士研究生,主要从事甲状腺癌及淋巴结癌转移术前相关风险的研究;通讯作者:苏新良(1965.9-),男,重庆人,博士,教授,主要从事甲状腺癌术前诊疗、手术方式及淋巴结清扫范围等研究。
