超声特征联合BRAF基因对PTC颈部淋巴结转移的预测价值研究-现代医学

超声特征联合BRAF基因对PTC颈部淋巴结转移的预测价值研究

单位：1. 南京医科大学第四附属医院超声医学科, 江苏南京 210031;
2. 南京医科大学附属南京医院/南京市第一医院心血管超声科, 江苏南京 210006

分类号：R445.1

出版年·卷·期（页码）：2025·53·第三期（405-411）

摘要：

目的：探讨超声特征联合BRAF基因对甲状腺乳头状癌(PTC)颈部淋巴结转移的预测价值，为临床诊治及评估PTC患者预后提供理论依据。方法：随机选取2021年12月至2023年12月就诊于南京医科大学第四附属医院PTC单发病灶者127例，按照术后颈部淋巴结病理结果分为转移组和未转移组。收集两组患者的一般资料、血清学指标、术后病理分期、术前超声特征及BRAF^V600E基因突变结果。对两组患者的上述指标进行差异性比较，多因素 Logistic 回归分析PTC患者发生颈部淋巴结转移的预测因素，对有预测价值的指标绘制受试者工作特征(ROC)曲线。结果：与未转移组比较，转移组年龄较小，多见男性，且结节较大，结节边界模糊、结节边缘可见毛刺、结节内部伴有微钙化、结节边缘距甲状腺包膜距离≤3 mm比例多，弹性模量平均值(Emean)高及BRAF^V600E基因有突变(均P<0.05)。多因素回归分析结果显示，年龄、结节边缘见毛刺、Emean及BRAF^V600E基因突变可作为预测PTC发生颈部淋巴结转移的独立危险因素(P＜0.05)。ROC曲线显示，多因素联合预测PTC发生颈部淋巴结转移的ROC曲线下面积、特异度、灵敏度均较单一因素高。结论： PTC发生颈部淋巴结转移的独立危险因素包括患者年龄、结节边缘见毛刺、结节硬度及BRAF^V600E基因突变。超声特征联合BRAF^V600E基因预测PTC患者发生颈部淋巴结转移的灵敏度和特异度远高于单一指标，值得临床应用及推广。

Objective: To investigate the predictive value of ultrasound features combined with BRAF gene for cervical lymph node metastasis in papillary thyroid carcinoma(PTC), providing a theoretical basis for the clinical diagnosis and treatment of patients with PTC and for assessing their prognosis. Methods: Randomly selected 127 patients with single-lesion PTC who were treated at the Fourth Affiliated Hospital of Nanjing Medical University from December 2021 to December 2023. These patients were divided into a metastasis group and a non-metastasis group according to the pathological results of postoperative cervical lymph nodes. General data, serological indicators, postoperative pathological staging, preoperative ultrasound characteristics, and the BRAF^V600Egene mutation results of two group of patients were collected. The above-mentioned indicators of the two groups of patients were compared for differences. Multivariate Logistic regression analysis was used to identify the predictive factors for cervical lymph node metastasis in PTC patients. For the indicators with predictive value, the receiver operating characteristic(ROC) curve was drawn. Results: Compared with the non-metastasis group, patients in the metastasis group were younger, more likely to be male, and had larger nodules, a higher proportion of blurred nodule boundaries, a higher proportion of burrs visible at the nodule margins, a higher proportion of micro-calcifications with the nodules, a higher proportion of nodules with a distance from the thyroid capsule ≤ 3 mm, high mean value of the elastic modulus(Emean) and BRAF^V600E gene mutations(all P＜0.05). The results of multivariate regression analysis indicated that age, burrs visible at the nodule margins, Emean and BRAF^V600E mutations could serve as independent risk factors for predicting cervical lymph node metastasis in PTC(P＜0.05). The area under the ROC curve，specificity and sensitivity for the combined prediction of cervical lymph node metastasis in PTC by multiple factors, which were all higher than those of single-factor prediction. Conclusion: Independent risk factors for cervical lymph node metastasis in PTC include patient age, spiculated margins, hardness, and BRAF^V600E gene mutation. The sensitivity and specificity of ultrasound features combined with BRAF^V600E gene mutation in predicting cervical lymph node metastasis in PTC patients are significantly higher than those of any single indicator, making it worthy of clinical application and promotion.

参考文献：

[1] JACOME C S,GARCIA A,GOLEMBIEWSKI E,et al.Physical examination of the thyroid:accuracy in detecting thyroid nodules and frequency of additional findings[J].Endocr Pract,2024,30(1):31-35.
[2] 孙萍萍.超声剪切波弹性成像在甲状腺良恶性肿瘤中的鉴别价值及超声征象特征研究[J].中国医疗器械信息,2024,30(2):14-16.
[3] 沈军婕,薛淑恒.超声引导下行FNAC检查鉴别甲状腺良恶性结节的临床价值分析[J].首都食品与医药,2019,26(24):111-112.
[4] 管文燕,郑金榆,聂岭,等.基因检测在甲状腺结节诊断中分层应用模式的研究[J].中华病理学杂志,2024,53(3):264-268.
[5] 牛亦奇,邓先兆,郭伯敏,等.基于加权基因共表达网络分析的BRAF突变分化型甲状腺癌预后标志物筛选[J].现代医学,2020,48(11):1385-1395.
[6] 倪晨,朱乔丹,欧笛,等.甲状腺乳头状癌高侵袭性亚型的超声特征及其研究进展[J].中华超声影像学杂志,2021,30(7):636-640.
[7] AMIN M B,EDGE S,GREENE F,et al.2017 AJCC cancer staging manual[M].Eighth ed.New York:Springer,2017.
[8] 江业慧,彭梅.基于应变式及剪切波弹性成像联合超声常规参数预测甲状腺乳头状癌颈部淋巴结转移的价值[J].中国超声医学杂志,2024,40(4):382-385.
[9] 赵博,胡静,王金锐,等.分化型甲状腺癌临床及超声特征与颈部淋巴结转移的相关性分析[J].中国超声医学杂志,2017,33(6):488-491.
[10] LIU J,JIA X,GU Y,et al.Thyroid parenchyma micro-calcifications on ultrasound for predicting lymph node metastasis in papillary thyroid carcinoma:a prospective multicenter study in China[J].Front Oncol,2021,11:609075.
[11] WU X,LI B L,ZHENG C J,et al.Predictive factors for central lymph node metastases in papillary thyroid micro-carcinoma[J].World J Clin Cases,2020,8(8):1350-1360.
[12] 刘莹,金朋,郭培杰,等.基于临床特征及超声特征的等回声甲状腺乳头状癌的预测模型[J].中国超声医学杂志,2023,39(10):1084-1087.
[13] 苏彪,史宜鑫,陈林,等.常规超声特征预测甲状腺乳头状癌颈部淋巴结转移的价值[J].中国超声医学杂志,2022,38(6):622-625.
[14] 王晓庆,魏玮,魏玺,等.甲状腺乳头状癌的超声表现及其与颈部中央区淋巴结转移的关系[J].中华肿瘤杂志,2018,40(3):196-200.
[15] 张晓梅,康燕飞,桑田,等.超声检查指标联合预测甲状腺乳头状癌颈部中央区淋巴结转移的价值研究[J].中国全科医学,2022,25(3):305-311.
[16] 林文松,黄冠,林宝行.甲状腺乳头状癌及其临床病理特征与Braf蛋白表达、BRAF V600E基因突变之间的关系[J].吉林医学,2024,45(2):262-265.
[17] BERTOL B C,MASSARO J D,DEBORTOLI G,et al.BRAF,TERT and HLA-G status in the papillary thyroid carcinoma:a clinicopathological association study[J].Int J Mol Sci,2023,24(15):12459.
[18] ZHAO W,HE L,ZHU J,et al.A nomogram model based on the preoperative clinical characteristics of papillary thyroid carcinoma with Hashimoto's thyroiditis to predict central lymph node metastasis[J].Clin Endocrinol(Oxf),2021,94(2):310-321.
[19] 李方圆,王翔,刘燕,等.甲状腺乳头状癌超声特征及BRAF基因与颈部淋巴结转移的关系[J].影像研究与医学应用,2024,8(10):44-46,50.

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