超声特征联合BRAFV600E基因对Bethesda Ⅲ类甲状腺结节良恶性的诊断效能OA
Diagnostic performance of combining sonographic features with BRAFV600E mutation for differentiating benign and malignant Bethesda category Ⅲ thyroid nodules
目的 探究超声特征联合BRAFV600E基因对Bethesda Ⅲ类甲状腺结节良、恶性的诊断效能.方法 本研究为回顾性队列研究,连续性纳入2020年1月至2024年12月在陆军军医大学第一附属医院超声科经超声引导下细针穿刺细胞学检查(ultrasound-guided fine needle aspiration cytology,US-FNAC)诊断为Bethesda Ⅲ类、且最终经手术病理或重复US-FNAC确诊的甲状腺患者275例(278个结节),以手术病理或重复US-FNAC确诊的病理结果为标准将结节分为良性与恶性,计算年龄、性别、超声特征(9项)、美国放射学会甲状腺超声影像报告与数据系统(American College of Radiology Thyroid Imaging Reporting and Data System,ACR TI-RADS)评分、US-FNAC细胞核形态、BRAFV600E基因对Bethesda Ⅲ类结节的诊断效能,采用多因素Logistic回归模型分析超声特征及联合BRAFV600E基因对Bethesda Ⅲ类甲状腺结节良、恶性的诊断效能.结果 患者年龄、结节边缘、结节纵横比、结节最大径、结节回声、Adler血流分级、ACR TI-RADS分类、US-FNAC细胞核形态以及BRAFV600E基因在甲状腺Bethesda Ⅲ类良、恶性结节中差异具有统计学意义(P均＜0.05).年龄≤52岁、BRAFV600E基因突变、细胞毛玻璃样核改变、颈部异常淋巴结是恶性结节的独立危险因素(OR值分别为7.444、108.218、5.389、13.351,P＜0.05),回归模型的准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为0.823、0.863、0.925、0.977、0.649,曲线下面积为0.955.结论 超声特征联合BRAFV600E基因对甲状腺Bethesda Ⅲ类良恶性结节有较高诊断效能.
Objective To evaluate the diagnostic performance of combining sonographic features with BRAFV600E mutation for differentiating benign and malignant Bethesda category Ⅲ thyroid nodules.Methods This retrospective cohort study included 275 patients(278 nodules)diagnosed as Bethesda category Ⅲ by ultrasound-guided fine needle aspiration cytology(US-FNAC)at First Affiliated Hospital of Army Medical University between January 2020 and December 2024,with final confirmation via surgical pathology or repeated US-FNAC.Nodules were classified as benign or malignant based on pathological results.Diagnostic efficacy of age,sex,9 sonographic features,ACR TI-RADS score,US-FNAC nuclear morphology,and BRAFV600E mutation was analyzed using multivariate logistic regression.Results Significant differences existed in age,nodule margin,aspect ratio,maximum diameter,echogenicity,Adler blood flow grading,ACR TI-RADS classification,US-FNAC nuclear morphology,and BRAFV600E status between benign and malignant nodules(all P＜0.05).Independent risk factors for malignancy included age≤52 years(OR=7.444),BRAFV600E mutation(OR=108.218),ground-glass nuclei(OR=5.389),and abnormal cervical lymph nodes(OR=13.351,P＜0.05).The combined model demonstrated accuracy was 0.823,sensitivity was 0.863,specificity was 0.925,positive predictive value was 0.977,negative predictive value was 0.649,and AUC was 0.955.Conclusion Integration of sonographic features and BRAFV600E mutation provides high diagnostic performance for Bethesda category Ⅲ thyroid nodules.
吴爽;李欣;唐春霖;陈萍;张君;黄海韵;郭燕丽
陆军军医大学(第三军医大学)第一附属医院超声科,重庆陆军军医大学(第三军医大学)第一附属医院超声科,重庆陆军军医大学(第三军医大学)第一附属医院超声科,重庆陆军军医大学(第三军医大学)第一附属医院超声科,重庆陆军军医大学(第三军医大学)第一附属医院超声科,重庆陆军军医大学(第三军医大学)第一附属医院超声科,重庆陆军军医大学(第三军医大学)第一附属医院超声科,重庆
医药卫生
甲状腺结节超声检查意义不明确的非典型BRAF
thyroid noduleultrasonographyatypia of undetermined significanceBRAF
《陆军军医大学学报》 2026 (4)
453-460,8
重庆市技术创新与应用发展专项重点项目(CSTB2022TIAD-KPX0153) Supported by the Chongqing Key Project of Technological Innovation and Application Development Special Program(CSTB2022TIAD-KPX0153).
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