[1]李雪松,苏新良,陶冬梅.术前诊断不明确的甲状腺乳头状癌的风险分析[J].医学信息,2024,37(04):119-123.[doi:10.3969/j.issn.1006-1959.2024.04.021]
　LI Xue-song,SU Xin-liang,TAO Dong-mei.Risk Analysis of Papillary Thyroid Carcinoma with Undefinable Preoperative Diagnosis[J].Journal of Medical Information,2024,37(04):119-123.[doi:10.3969/j.issn.1006-1959.2024.04.021]
点击复制

术前诊断不明确的甲状腺乳头状癌的风险分析()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
37卷
期数:
2024年04期
页码:
119-123
栏目:
论著
出版日期:
2024-02-15

文章信息/Info

Title:
Risk Analysis of Papillary Thyroid Carcinoma with Undefinable Preoperative Diagnosis
文章编号:
1006-1959（2024）04-0119-05
作者:
李雪松; 苏新良; 陶冬梅
（重庆医科大学附属第一医院内分泌乳腺外科，重庆 400016）
Author(s):
LI Xue-song; SU Xin-liang; TAO Dong-mei
(Department of Endocrine and Breast Surgery,the First Affiliated Hospital of Chongqing Medica University,Chongqing 400016,China)
关键词:
甲状腺乳头状癌; 细针穿刺细胞学诊断; BrafV600E基因; 淋巴结转移
Keywords:
Papillary thyroid carcinoma; Fine needle aspiration cytology; BRAFV600E gene; Lymph node metastasis
分类号:
R631
DOI:
10.3969/j.issn.1006-1959.2024.04.021
文献标志码:
A
摘要:
目的 探讨临床病理特征和Braf基因检测在术前细针穿刺细胞学诊断不明确的甲状腺乳头状癌的相关风险。方法 选取2017年1月-2020年8月首次收入重庆医科大学附属第一医院穿刺病理诊断不明确的患者962例，所有患者均已完善术前相关检查并于我院行甲状腺手术治疗,回顾性分析临床特征和Braf基因检测与乳头状癌相关性，使用单因素分析及二元Logistic回归分析确定独立危险因素并预测结果。结果 在962例患者中，Braf基因突变型（突变率为89.50%）与PTC存在显著相关（OR=22.564，95%CI：10.125~50.285，P=0.000）。此外TI-RADS分类为4B类及以上（OR=1.633，95%CI：1.019~2.616，P=0.041），结节＜1 cm（OR=0.420，95%CI：0.279~0.634，P=0.000）的患者术后病检为PTC的比例更高。在预测颈部淋巴结转移的情况中，Braf基因突变型（OR=2.126，95%CI：1.316~3.432，P=0.002）、男性患者（OR=2.102，95%CI：1.532~2.884，P=0.000)、结节＞1 cm（OR=1.581，95%CI：1.218~2.054，P=0.001）、TI-RADS分类为4B类及以上（OR=1.368，95%CI：1.186~1.578，P=0.000）其术后病检淋巴结转移比例和风险更高。而年龄＞45岁（OR=0.741，95%CI：0.649~0.846，P=0.000）是PTC淋巴结转移的保护性因素。结论 在术前穿刺诊断不明确的患者中，Braf基因突变可以作为PTC的辅助诊断工具，Braf基因检测联合FNAC诊断可增加术前诊断的精确性,减少漏诊率。Braf基因突变型、TI-RADS分类4B类及以上及结节大小＜1 cm可以作为预测PTC的独立危险因素。结合Braf基因突变型、患者男性、年龄＜45岁、TI-RADS分类为4B类及以上及结节大小＞1 cm可作为预测PTC淋巴结转移（LNM）的独立预测因子。
Abstract:
Objective To investigate the risk of clinicopathological features and Braf gene detection in papillary thyroid carcinoma with undefinable preoperative fine needle aspiration cytology.Methods The clinicopathological data of 962 undefinable preoperative diagnosed patients were included from January 2017 to August 2020 in the First Affiliated Hospital of Chongqing Medical University. All patients had completed preoperative examination and underwent thyroid surgery in our hospital. The clinical characteristics and the correlation between Braf gene detection and papillary carcinoma were retrospectively analyzed. Univariate analysis and binary logistic regression analysis were used to determine independent risk factors and predict results.Results In 962 patients, Braf gene mutation (mutation rate was 89.50%) was significantly associated with PTC (OR=22.564,95%CI:10.125-50.285,P=0.000). In addition, the proportion of PTC was higher in patients with TI-RADS classification was 4B and above (OR=1.633,95%CI:1.019-2.616,P=0.041) and nodules<1 cm (OR=0.420,95%CI:0.279-0.634,P=0.000). In the prediction of cervical lymph node metastasis, the proportion and risk of postoperative pathological lymph node metastasis were higher in BRAF gene mutation type (OR=2.126,95%CI:1.316-3.432,P=0.002), male patients (OR=2.102,95%CI:1.532-2.884,P=0.000), nodules>1 cm (OR=1.581,95%CI:1.218-2.054,P=0.001), and TI-RADS classification of 4B and above (OR=1.368,95%CI:1.186-1.578,P=0.000). While, Age>45 years old (OR=0.741,95%CI:0.649-0.846,P=0.000) was a protective factor for lymph node metastasis in PTC.Conclusion In patients with undefinable preoperative diagnosis, Braf gene mutation can be used as a tool to assist in the diagnosis of thyroid papillary carcinoma. Braf gene detection combined with FNAC diagnosis can increase the accuracy of preoperative diagnosis and reduce the rate of missed diagnosis. Braf gene mutation type, TI-RADS classification 4B and above, and nodule size <1 cm can be used as independent risk factors for predicting PTC. Combined with Braf gene mutation type, male patient, age<45 years old, TI-RADS classification of 4B and above and nodule size>1 cm, it can be used as an independent predictor of lymph node metastasis (LNM) in PTC.

参考文献/References:

[1]郑荣寿,张思维,孙可欣,等.2016年中国恶性肿瘤流行情况分析[J].中华肿瘤杂志,2023,45(3):212-220.[2]王冰,张明博,万政,等.动态人工智能超声辅助诊断系统对甲状腺结节诊断价值研究[J].中国实用外科杂志,2022,42(6):680-684.[3]中国医师协会外科医师分会甲状腺外科医师委员会,中国研究型医院学会甲状腺疾病专业委员会,中国医学装备协会外科装备分会甲状腺外科装备委员会.超声引导下甲状腺结节细针穿刺活检专家共识及操作指南(2018版)[J].中国实用外科杂志,2018,38(3):241-244.[4]Wada N,Duh QY,Sugino K,et al.Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection[J].Ann Surg,2003,237(3):399-407.[5]Ball DW.American Thyroid Association guidelines for management of medullary thyroid cancer: an adult endocrinology perspective[J].Thyroid,2009,19(6):547-550.[6]Yang L,Shen W,Sakamoto N.Population-based study evaluating and predicting the probability of death resulting from thyroid cancer and other causes among patients with thyroid cancer[J].J Clin Oncol,2013,31(4):468-474.[7]中国抗癌协会甲状腺癌专业委员会(CATO).甲状腺微小乳头状癌诊断与治疗中国专家共识（2016版）[J].中国肿瘤临床,2016,43(10):405-411.[8]Xu JM,Chen YJ,Dang YY,et al.Association Between Preoperative US, Elastography Features and Prognostic Factors of Papillary Thyroid Cancer With BRAFV600E Mutation[J].Front Endocrinol (Lausanne),2020,10:902.[9]Xue S,Zhang L,Wang P,et al.Predictive Factors of Recurrence for Multifocal Papillary Thyroid Microcarcinoma With Brafv600e Mutation: A Single Center Study of 1,207 Chinese Patients[J].Front Endocrinol (Lausanne),2019,10:407.[10]Cibas ES,Ali SZ.The 2017 Bethesda System for Reporting Thyroid Cytopathology[J].Thyroid,2017,27(11):1341-1346.[11]Alexander EK,Pearce EN,Brent GA,et al.2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum[J].Thyroid,2017,27(3):315-389.[12]Ross DS,Burch HB,Cooper DS,et al.2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis[J].Thyroid,2016,26(10):1343-1421.[13]Haugen BR,Alexander EK,Bible KC,et al.2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer[J].Thyroid,2016,26(1):1-133.[14]Alexander EK,Cibas ES.Diagnosis of thyroid nodules[J].Lancet Diabetes Endocrinol,2022,10(7):533-539.[15]Trimboli P,Treglia G,Condorelli E,et al.BRAF-mutated carcinomas among thyroid nodules with prior indeterminate FNA report: a systematic review and meta-analysis[J].Clin Endocrinol (Oxf),2016,84(3):315-320.[16]Kauffmann RM,Hamner JB,Ituarte PHG,et al.Age greater than 60 years portends a worse prognosis in patients with papillary thyroid cancer: should there be three age categories for staging?[J].BMC Cancer,2018,18(1):316.[17]Shu X,Tang L,Hu D,et al.Prediction Model of Pathologic Central Lymph Node Negativity in cN0 Papillary Thyroid Carcinoma[J].Front Oncol,2021,11:727984.[18]Choi JE,Bae JS,Lim DJ,et al.Atypical Histiocytoid Cells and Multinucleated Giant Cells in Fine-Needle Aspiration Cytology of the Thyroid Predict Lymph Node Metastasis of Papillary Thyroid Carcinoma[J].Cancers (Basel),2019,11(6):816.[19]Jia Y,Yu Y,Li X,et al.Diagnostic value of B-RAF(V600E) in difficult-to-diagnose thyroid nodules using fine-needle aspiration: systematic review and meta-analysis[J].Diagn Cytopathol,2014,42(1):94-101.[20]Xing M,Alzahrani AS,Carson KA,et al.Association between BRAF V600E mutation and mortality in patients with papillary thyroid cancer[J].JAMA,2013,309(14):1493-1501.

相似文献/References:

[1]刘 彻,艾力·赛丁,苏鹏程.甲状腺乳头状癌颈部淋巴结转移特点及相关危险因素分析[J].医学信息,2019,32(23):70.[doi:10.3969/j.issn.1006-1959.2019.23.019]
　LIU Che,Aili·SaiDing,SU Peng-cheng.Analysis of Cervical Lymph Node Metastasis and Related Risk Factors in Papillary Thyroid Carcinoma[J].Journal of Medical Information,2019,32(04):70.[doi:10.3969/j.issn.1006-1959.2019.23.019]
[2]唐嘉晨,郝玲玲,秦晓茹,等.全腔镜下甲状腺乳头状癌并发症Meta分析[J].医学信息,2021,34(04):78.[doi:10.3969/j.issn.1006-1959.2021.04.021]
　TANG Jia-chen,HAO Ling-ling,QIN Xiao-ru,et al.Meta-analysis of Complications of Papillary Thyroid Carcinoma Under Full Laparoscopic Surgery[J].Journal of Medical Information,2021,34(04):78.[doi:10.3969/j.issn.1006-1959.2021.04.021]
[3]李 想,孙春雷,张 懿,等.无充气腋窝入路腔镜手术治疗甲状腺乳头状癌的疗效研究[J].医学信息,2021,34(04):115.[doi:10.3969/j.issn.1006-1959.2021.04.030]
　LI Xiang,SUN Chun-lei,ZHANG Yi,et al.Study on the Curative Effect of Laparoscopic Surgery Non-inflated Axillary Approach in the Treatment of Papillary Thyroid Carcinoma[J].Journal of Medical Information,2021,34(04):115.[doi:10.3969/j.issn.1006-1959.2021.04.030]
[4]范雪峰,王伦锋,余招焱,等.左侧及右侧中央区淋巴结清扫在甲状腺乳头状癌术中的应用[J].医学信息,2021,34(09):5.[doi:10.3969/j.issn.1006-1959.2021.09.002]
　FAN Xue-feng,WANG Lun-feng,YU Zhao-yan,et al.Left and Right Central Lymph Node Dissection in the Operation of Papillary Thyroid Carcinoma[J].Journal of Medical Information,2021,34(04):5.[doi:10.3969/j.issn.1006-1959.2021.09.002]
[5]徐海燕,潘景润,宫希军,等.CT增强联合甲状腺球蛋白及抗体在甲状腺乳头状癌颈部淋巴结转移中的预测价值[J].医学信息,2021,34(20):119.[doi:10.3969/j.issn.1006-1959.2021.20.030]
　XU Hai-yan,PAN Jing-run,GONG Xi-jun,et al.The Value of CT Enhancement Combined with Thyroglobulin and Antibody in PredictingCervical Lymph Node Metastasis of Papillary Thyroid Carcinoma[J].Journal of Medical Information,2021,34(04):119.[doi:10.3969/j.issn.1006-1959.2021.20.030]
[6]李佳楠,陈春悠.STAT3、NCK1和VEGF在甲状腺乳头状癌中的表达及临床意义[J].医学信息,2022,35(05):94.[doi:10.3969/j.issn.1006-1959.2022.05.023]
　LI Jia-nan,CHEN Chun-you.Expression of STAT3, NCK1 and VEGF in Papillary Thyroid Carcinoma and its Clinical Significance[J].Journal of Medical Information,2022,35(04):94.[doi:10.3969/j.issn.1006-1959.2022.05.023]
[7]郑时玉,郭亚男.c-Met及MACC1在甲状腺乳头状癌中的表达及临床意义[J].医学信息,2022,35(15):36.[doi:10.3969/j.issn.1006-1959.2022.15.007]
　ZHENG Shi-yu,GUO Ya-nan.Expression and Clinical Significance of c-Met and MACC1 in Papillary Thyroid Carcinoma[J].Journal of Medical Information,2022,35(04):36.[doi:10.3969/j.issn.1006-1959.2022.15.007]
[8]曾恒栋.CT鉴别诊断甲状腺乳头状癌与结节性甲状腺肿的临床价值[J].医学信息,2024,37(22):165.[doi:10.3969/j.issn.1006-1959.2024.22.041]
　ZENG Hengdong.Clinical Value of CT in Differential Diagnosis of Papillary Thyroid Carcinoma and Nodular Goiter[J].Journal of Medical Information,2024,37(04):165.[doi:10.3969/j.issn.1006-1959.2024.22.041]

更新日期/Last Update: 1900-01-01