常规超声及超声造影特征联合BRAF V600E基因预测甲状腺乳头状癌颈部淋巴结转移的价值OA
The Value of Conventional Ultrasound and Contrast-enhanced Ultrasound Features Combined with BRAF V600E Gene in Predicting Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma
目的:探讨常规超声(US)、超声造影(CEUS)特征联合BRAF V600E基因突变在预测甲状腺乳头状癌(PTC)颈部淋巴结转移(CLNM)中的价值,为术前风险分层提供依据.方法:经我院伦理委员会批准,回顾性纳入新疆医科大学第一附属医院2022年9月至2024年5月收治的162例PTC患者(162个结节),根据术后病理结果分为CLNM转移组(76例)与未转移组(86例).纳入标准:①术前1周内完成US、CEUS及BRAF V600E检测;②术后病理明确CLNM状态.采用单因素及多因素Logistic回归分析筛选独立预测因素,构建列线图模型,并通过内部验证(Bootstrap重复抽样法)评估模型效能.结果:多因素分析显示,年龄≤45岁(OR=3.828,95％CI:1.748～8.383)、BRAF V600E 阳性(OR=5.302,95％CI:1.189～23.635)、多灶性(OR=3.524,95％CI:1.562～7.952)、结节最大径≥1 cm(OR=2.270,95％CI:1.010～5.101)、微钙化数量＞5个(OR=3.243,95％CI:1.485～7.082)及CEUS被膜连续性中断(OR=4.913,95％CI:1.819～13.268)为CLNM的独立危险因素(均P＜0.05).列线图模型预测CLNM的AUC为0.836(95％CI:0.775～0.897),Bootstrap 内部验证(1 000次)校正后 AUC为 0.814(95％CI:0.749～0.818),校准曲线(Hosmer-Lemeshow检验P=0.744)与决策曲线分析显示临床适用性良好.结论:联合US、CEUS特征及BRAF V600E基因构建的列线图模型可有效预测PTC患者CLNM风险,为个体化诊疗提供参考.本研究为单中心回顾性分析,需多中心前瞻性研究进一步验证.
Objective:To investigate the value of conventional ultrasound(US),contrast-enhanced ultrasound(CEUS)features combined with BRAF V600E gene mutation in predicting cervical lymph node metastasis(CLNM)in papillary thyroid carcinoma(PTC),and to provide a basis for preoperative risk stratification.Methods:A retrospective analysis was conducted on 162 PTC patients(162 nodules)admitted to the First Affiliated Hospital of Xinjiang Medical University between September 2022 and May 2024.Patients were divided into CLNM-positive(76 cases)and CLNM-negative(86 cases)groups based on postoperative pathological results.Inclusion criteria:①US,CEUS,and BRAF V600E testing were completed within 1 week preoperatively;②Postoperative pathological confirmation of CLNM status.Univariate and multivariate Logistic regression analyses were performed to identify independent predictive factors,followed by the construction of a nomogram model.Model performance was evaluated using an internal validation(Bootstrap resampling method with 1000 iterations).Results:Multivariate analysis identified the following independent risk factors for CLNM(all P＜0.05):age≤45 years(OR=3.828,95％CI:1.748～8.383),BRAF V600E positivity(OR=5.302,95％CI:1.189～23.635),multifocality(OR=3.524,95％CI:1.562～7.952),nodule maximum diameter ≥1 cm(OR=2.270,95％CI:1.010～5.101),microcalcification count＞5(OR=3.243,95％CI:1.485～7.082),and post-CEUS disruption of the capsule continuity(OR=4.913,95％CI:1.819～13.268).The nomogram model achieved an area under the curve(AUC)of 0.836(95％CI:0.775～0.897)and the Bootstrap-validated(B=1 000)AUC was 0.814(95％CI:0.749～0.818).Calibration curves(Hosmer-Lemeshow test,P=0.744 and decision curve analysis demonstrated good clinical applicability.Conclusion:The nomogram model integrating US,CEUS features,and BRAF V600E gene mutation effectively predicts CLNM risk in PTC patients,providing a reference for individualized diagnosis and treatment.This study is a single-center retrospective analysis,and further validation through multi-center prospective studies is warranted.
庄晓晨;李智铭;苟政江;宋涛
新疆医科大学第一附属医院腹部超声诊断科,新疆 830054新疆医科大学第一附属医院腹部超声诊断科,新疆 830054新疆医科大学第一附属医院腹部超声诊断科,新疆 830054新疆医科大学第一附属医院腹部超声诊断科,新疆 830054
医药卫生
甲状腺乳头状癌颈部淋巴结转移列线图超声造影BRAF V600E基因
papillary thyroid carcinomacervical lymph node metastasisnomogramcontrast-enhanced ultrasoundBRAF V600E gene
《影像科学与光化学》 2026 (6)
80-86,7
"青年科研启航"专项基金项目(2022YFY-QKQN-13)中央引导地方科技发展专项资金项目(ZYYD2024JD12).
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