甲状腺乳头状癌患者术前超声联合BRAF基因对淋巴结分期的诊断价值

雷威; 李慧; 马志强

doi:10.16766/j.cnki.issn.1674-4152.002511

甲状腺乳头状癌患者术前超声联合BRAF基因对淋巴结分期的诊断价值

doi: 10.16766/j.cnki.issn.1674-4152.002511

雷威¹,
李慧²,
马志强^3, ,

1.
郑州大学第一附属医院超声医学科, 河南郑州 450052
2.
河南大学第一附属医院超声医学科, 河南开封 475000
3.
河南大学第一附属医院乳腺甲状腺外科

基金项目:

河南省医学科技攻关计划项目 LHGJ20200544

详细信息

通讯作者:
马志强，E-mail: moon21@126.com

中图分类号: R736.1 R445.1
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- 被引次数: 0
出版历程
- 收稿日期: 2021-05-13
- 网络出版日期: 2022-09-21

Diagnostic value of preoperative ultrasound combined with BRAF gene in lymph node staging in patients with papillary thyroid carcinoma

LEI Wei¹,
LI Hui²,
MA Zhi-qiang^{3
, ,}

1.
Department of Ultrasound Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henson of clinical characteristican 450052, China

摘要

摘要: 目的探讨超声联合BRAF基因突变检测在甲状腺乳头状癌(PTC)术前诊断率方面的差异, 为临床是否选择手术治疗及其手术方式的选择提供科学、可靠的影像学及分子学依据。方法回顾性分析2020年1-10月河南大学第一附属医院收治的120例PTC患者, 根据美国癌症联合委员会(AJCC)甲状腺癌分期系统标准, 将PTC患者分为N0、N1a与N1b期。120例患者术前均进行超声检查, 进行甲状腺切除手术治疗, 以病理组织学诊断结果为金标准。分析PTC超声声像图、患者性别、年龄、BRAF基因检测结果及N0与N1组, N1b与非N1b间的差异; 采用单因素和多因素logistic回归分析对可能影响PTC N分期的相关因素进行分析。结果 120例PTC患者中, 63例患者病理诊断为N0期, 38例为N1a期, 19例为N1b期, N1期共57例; 超声诊断结果显示, 57例为N0期, 45例为N1a期, 18例为N1b期, N1期共63例。术前超声评估N分期与病理诊断结果, N分期具有一致性, 差异有统计学意义(Kappa=0.725, P < 0.05)。N0期和N1期患者的年龄、肿瘤直径、BRAF基因突变差异有统计学意义(均P < 0.05)。非N1b期和N1b期患者的肿瘤直径、多发病灶、包膜外侵犯比较差异有统计学意义(均P < 0.05)。多因素logistic回归分析结果显示, 年龄、肿瘤直径、BRAF基因突变是N0期和N1期的影响因素(均P < 0.05);肿瘤直径>1 cm、多发病灶、包膜外侵犯是影响N1b期的独立危险因素(均P < 0.05)。结论结合超声检查和年龄、肿瘤直径、BRAF基因、多发病灶、包膜外侵犯临床相关影响指标与PTC的N分期有关。术前超声检查可用于PTC N分期评估, 有助于辅助临床诊断与治疗。
- 超声 /
- 甲状腺乳头状癌 /
- N分期
Abstract: Objective To investigate the difference in the preoperative diagnostic rate of papillary thyroid carcinoma (PTC) by using ultrasound combined with BRAF gene mutation detection, and to provide scientific and reliable imaging and molecular basis for the selection of surgical treatment and surgical method. Methods A total of 120 patients with PTC admitted to our hospital from January to October 2020 were retrospectively analysed.According to the American Joint Committee on Cancer thyroid cancer staging system standard, patients with PTC were divided into three groups: N0, N1a and N1b.All 120 patients underwent preoperative ultrasound examination and thyroidectomy, and the pathological diagnosis was the gold standard.PTC ultrasonography, gender, age, BRAF gene test results and Hashimoto's thyroiditis background were analysed between N0 and N1 groups and between N1b and non-N1b groups.Univariate and multivariate logistic regression analysis were used to compare the related factors that may affect PTC N staging. Results Amongst 120 PTC patients, 63 patients were pathologically diagnosed as N0 stage, 38 as N1a stage, 19 as N1b stage and 57 as N1 stage.Ultrasonic diagnosis showed that 57 cases were N0 stage, 45 cases were N1a stage, 18 cases were N1b stage, and 63 cases were N1 stage.Preoperative ultrasound assessment of N stage was consistent with pathological diagnosis, and the difference was statistically significant (Kappa=0.725, P < 0.05).There were significant differences in age, tumour diameter and BRAF gene mutation between N0 and N1 patients (all P < 0.05).There were significant differences between non-N1B stage and N1b stage patients in tumour diameter, multiple lesions and extracapsular invasion (all P < 0.05).Multivariate logistic regression analysis showed that age, tumour diameter and BRAF gene mutation were independent influencing factors for N0 stage and N1 stage (all P < 0.05), while tumour diameter>1 cm, multiple lesions and extracapsular invasion were independent risk factors for N1b stage (all P < 0.05). Conclusion Combined with ultrasound examination, age, tumour diameter, BRAF gene, multiple lesions and extracapsular invasion, clinical-related influencing indicators are correlated with N stage of PTC.Preoperative ultrasonography can be used to evaluate PTC N staging, which is helpful to assist clinical diagnosis and treatment.
- Ultrasonography /
- Papillary thyroid carcinoma /
- N stages

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图 1 不同N分期的PTC超声图像

注：A为N0期；B为N1a期；C为N1b期。

Figure 1. Ultrasound images of PTC in different N stages

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图 2 术前超声评估PTC患者N分期的ROC曲线

Figure 2. ROC curve of N staging of PTC patients assessed by preoperative ultrasound

下载: 全尺寸图片幻灯片

表 1 术前超声诊断PTC分期与病理诊断结果比较(例)

Table 1. Comparison of preoperative ultrasound diagnosis of PTC staging and pathological results (cases)

超声N分期	病理N分期			合计
超声N分期	N0期	N1a期	N1b期	合计
N0期	51	6	0	57
N1a期	10	28	7	45
N1b期	2	4	12	18
合计	63	38	19	120
注：2种方法比较，Kappa=0.725，P=0.008。

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表 2 N0期和N1期PTC患者临床特征比较[例(%)]

Table 2. Comparison of clinical characteristics of patients with PTC in N0 and N1 stages [cases (%)]

项目	类别	N0期 (n=63)	N1期 (n=57)	χ²值	P值
性别	男性	14(22.22)	12(21.05)	0.024	0.877
	女性	49(77.78)	45(78.95)
年龄(岁)	＜55	36(57.14)	51(89.47)	15.689	< 0.001
	≥55	27(42.86)	6(10.53)
肿瘤直径(cm)	＞1	26(41.27)	36(63.16)	5.741	0.017
	≤1	37(58.73)	21(36.84)
多发病灶	是	20(31.75)	18(31.58)	< 0.001	0.984
	否	43(68.25)	39(68.42)
包膜外侵犯	是	21(33.33)	20(35.09)	0.041	0.840
	否	42(66.67)	37(64.91)
慢性桥本甲状腺炎	是	22(34.92)	20(35.09)	< 0.001	0.985
	否	41(65.08)	37(64.91)
BRAF基因	阳性	25(39.68)	37(64.91)	9.224	0.010
	阴性	14(22.22)	11(19.30)
	不确定	24(38.10)	9(15.79)

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表 3 非N1b期和N1b期患者的临床特征比较[例(%)]

Table 3. Comparison of clinical characteristics of patients with non-N1b stage and N1b stage [cases (%)]

项目	类别	非N1b期 (n=101)	N1b期 (n=19)	χ²值	P值
性别	男性	21(20.79)	5(26.32)	0.287	0.592
	女性	80(79.21)	14(73.68)
年龄(岁)	＜55	86(85.15)	16(84.21)	0.011	0.916
	≥55	15(14.85)	3(15.79)
肿瘤直径(cm)	＞1	40(39.60)	15(78.95)	9.971	0.002
	≤1	61(60.40)	4(21.05)
多发病灶	是	28(27.72)	13(68.42)	11.776	0.001
	否	73(72.28)	6(31.58)
包膜外侵犯	是	36(35.64)	15(78.95)	12.271	< 0.001
	否	65(64.36)	4(21.05)
慢性桥本甲状腺炎	是	35(34.65)	7(36.84)	0.034	0.854
	否	66(65.35)	12(63.16)
BRAF基因	阳性	45(44.55)	8(42.11)	0.126	0.939
	阴性	23(22.77)	4(21.05)
	不确定	33(32.67)	7(36.84)

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表 4 N0期和N1期的logistic回归分析结果

Table 4. Logistic regression analysis results of N0 and N1 stages

项目	B	SE	Wald χ²	P值	OR(95% CI)
年龄	1.854	0.528	12.334	< 0.001	6.386(2.269~17.973)
肿瘤直径	0.894	0.418	4.565	0.033	2.444(1.077~5.547)
BRAF基因突变(阳性)	1.165	0.508	5.257	0.022	3.206(1.184~8.677)
BRAF基因突变(阴性)	0.441	0.609	0.524	0.469	1.555(0.417~5.133)
注：因变量为是否N1期，否=0，是=1；自变量赋值如下，年龄 < 55岁=1，≥55岁=0；肿瘤直径>1 cm=1，≤1 cm=0；BRAF基因突变，不确定为(0，0)，阳性为(1，0)，阴性为(0，1)。

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表 5 N1b与非N1b的logistic回归分析结果

Table 5. Logistic regression analysis results of N1b and non-N1b

项目	B	SE	Wald χ²	P值	OR(95% CI)
肿瘤直径>1 cm	1.296	0.641	4.090	0.043	3.653(1.041~12.824)
多发病灶	1.295	0.588	4.853	0.028	3.651(1.154~11.557)
包膜外侵犯	1.497	0.636	5.532	0.019	4.468(1.283~15.556)
注：因变量为是否N1b期，否=0，是=1；自变量赋值如下，肿瘤直径>1 cm=1，≤1 cm=0；多发病灶，是=1，否=0；包膜外侵犯，是=1，否=0。

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