摘要
目的探讨超声引导下细针穿刺细胞学检查(US-FNA)联合BRAF V600E突变检测与经典型甲状腺乳头状癌(PTC)患者颈部中央区淋巴结转移的相关性,为临床对患者进行术前病情评估提供可靠的分子学依据。方法选择2017年10月至2018年11月于甘肃省人民医院就诊的TI-RADS≥4a级、US-FNA高度可疑PTC、行双侧甲状腺切除术及颈部中央区淋巴结清扫术,并获得术后病理结果为经典型PTC及颈部中央区淋巴结病理结果的患者93例,穿刺所得标本部分应用HE染色,进行细胞学诊断,部分应用实时荧光定量聚合酶链式反应(PCR)法进行BRAF V600E基因突变检测。结果单因素分析显示,经典型PTC颈部中央区淋巴结转移的危险因素为女性(χ2=10.303,P=0.002)、BRAF V600E基因突变(χ2=31.204,P=0.000)和被膜侵犯(χ2=12.848,P=0.000)。Logistic多因素回归分析发现:BRAF V600E基因突变(OR=13.324,95%CI=4.058~43.744,P=0.000)、被膜侵犯(OR=5.738,95%CI=1.766~18.643,P=0.004)为经典型PTC颈部中央区淋巴结转移的危险因素,而与女性(OR=0.385,95%CI=0.112~1.324,P=0.130)无相关性。结论US-FNA联合BRAF V600E基因突变检测阳性与被膜侵犯是经典型PTC颈部中央区淋巴结转移的危险因素,有颈部中央区淋巴结转移危险因素者应行预防性颈部中央区淋巴结清扫。
Objective To explore the correlation of ultrasound-guided fine-needle aspiration(US-FNA)combined with BRAF V600E mutation detection and ultrasound features and central cervical lymph nodes metastasis of classic papillary thyroid cancer(PTC)for providing a reliable molecular basis for clinical preoperative evaluation of patients.Methods Ninty-three cases of patients collected from October 2017 to November 2018 in Gansu Province Hospital were enrolled,who underwent general ultrasonic examination TI-RADS≥4a,the US-FNA highly suspicious of PTC,thyroid surgery including total thyroidectomy and central cervical lymph node dissection,with the postoperative pathologic results of classical PTC and whether the central cervical lymph node metastasis happened in the patients.Part of the specimen applied HE staining for cytological diagnosis,the other part of specimen was used real-time for detection of BRAF V600E gene mutation by fluorescent quantitative polymerase chain reaction(PCR)method.Results Univariate analysis showed that the occurrence of cervical lymph node metastasis for classic PTC were significantly correlated with gender(χ2=10.303,P=0.002),BRAF V600E mutation(χ2=31.204,P=0.000)and extrathyroidal invasion(χ2=12.848,P=0.000).Multi-logistic regression analysis showed that BRAF V600E mutation(OR=13.324,95%CI=4.058-43.744,P=0.000)and extrathyroidal invasion(OR=5.738,95%CI=1.766-18.643,P=0.004)were the risk predictors of cervical lymph node metastasis of classic PTC.Gender(OR=0.385,95%CI=0.112-1.324,P=0.130)was not the risk predictor.Conclusions US-FNA combined with BRAF V600E mutation and extrathyroidal invasion are the risk factors in predicting central cervical lymph node metastasis in classic PTC.Patients with these two risk factors should be elected to undergo prophylactic central cervical lymph node dissection.
作者
李若暄
周祖邦
谢金会
王菲
慈霞
姜自容
时润莉
Li Ruoxuan;Zhou Zubang;Xie Jinhui;Wang Fei;Ci Xia;Jiang Zirong;Shi Runli(Medical School,Lanzhou University,Lanzhou 730000,China;Department of Ultrasound,Gansu Province Hospital,Lanzhou 730000,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2019年第12期1056-1060,共5页
Chinese Journal of Ultrasonography
基金
甘肃省人民医院院内科研基金项目(17GSSY6-11)
甘肃省人民医院院内培育科研项目(19SYPYB-26)。
