超声结合BRAFV600E基因突变检测在桥本甲状腺炎合并甲状腺结节鉴别中的应用价值

The value of ultrasound scan combined with BRAFV600E gene mutation analysis in the differential diagnosis of benign and malignant thyroid nodules in Hashimoto's thyroiditis

摘要:

目的 采用超声、BRAFV600E基因突变检测桥本甲状腺炎合并甲状腺结节，探讨两者联合检测对桥本甲状腺炎合并甲状腺结节良恶性的诊断价值。方法 选取2017年9月—2019年10月在惠州市中心人民医院就诊的桥本甲状腺炎合并甲状腺结节患者329例为研究对象，根据病理确诊甲状腺结节良恶性分为恶性组（177例）和良性组（152例）。采用超声、BRAFV600E基因突变检测桥本甲状腺炎合并甲状腺结节情况，并分析超声、BRAFV600E基因突变及两者联合检测对桥本甲状腺炎合并甲状腺结节良恶性的诊断价值。结果 金标准、超声、BRAFV600E基因突变诊断甲状腺炎合并甲状腺结节恶性分别为177例、167例、163例，良性分别为152例、162例、166例。超声、BRAFV600E基因突变、两者联合检测桥本甲状腺炎合并甲状腺结节恶性的敏感性分别为72.31%、65.54%和85.31%，特异性分别为74.34%、69.08%和71.71%，准确度分别为73.25%、67.17%和79.03%。与超声比较，两者联合诊断敏感性较高（P <0.0125），BRAFV600E基因突变诊断准确度较低（P <0.0125）；与BRAFV600E基因突变比较，两者联合诊断敏感性、准确度较高（P <0.0125）。结论 超声、BRAFV600E基因突变均对桥本甲状腺炎合并甲状腺结节良恶性具有一定诊断价值，单两者联合优于单独诊断。

Abstract:

Objective To study the value of the combination of ultrasound scan and BRAFV600E gene detection in differentially diagnosing benign and malignant thyroid nodules in Hashimoto's thyroiditis.Methods From September 2017 to October 2019, the 329 patients with Hashimoto's thyroiditis and thyroid nodules were enrolled and divided into malignant group (n =177) and benign group (n =152) according to the pathological diagnosis (gold standard). The values of ultrasound scan or BRAFV600E gene detection alone and their combination in the differential diagnosis of the benign and malignant thyroid nodules in Hashimoto's thyroiditis were analyzed.Results There were 177, 167 and 163 cases of Hashimoto's thyroiditis with malignant thyroid nodules, and 152, 162 and 166 cases of Hashimoto's thyroiditis with benign thyroid nodules diagnosed with the gold standard, ultrasound scan and BRAFV600E gene mutation analysis, respectively. The diagnostic sensitivity of ultrasound scan, BRAFV600E gene mutation analysis and their combination was severally 72.31%, 65.54% and 85.31%, with the specificity being 74.34%, 69.08% and 71.71%, and the accuracy being 73.25%, 67.17% and 79.03%. In comparison with the ultrasound scan alone, the diagnostic sensitivity of ultrasound scan combined with BRAFV600E gene mutation analysis was higher (P < 0.0125), while that of BRAFV600E gene mutation analysis alone was lower (P < 0.0125). Compared with BRAFV600E gene mutation analysis alone, the diagnostic sensitivity and specificity of ultrasound scan combined with BRAFV600E gene mutation analysis were both higher (P < 0.0125).Conclusions The ultrasound scan, BRAFV600E gene mutation analysis and their combination are all of diagnostic value in differentiating benign from malignant thyroid nodules in Hashimoto's thyroiditis, and the combined diagnosis is superior to the diagnosis alone.