Application value of thyroid nodule fine needle aspiration cytology combined with BRAF gene detection in the differential diagnosis of benign and malignant thyroid tumors

doi:10.11958/20241258

Abstract

Abstract:

Objective To explore the value of thyroid nodule fine needle aspiration cytology (FNAC) combined with B-Raf proto-oncogene, serine/threonine kinase (BRAF) gene detection in the differential diagnosis of benign and malignant thyroid tumors. Methods According to the results of pathological examination, 198 patients with thyroid nodules were divided into the benign lesion group (n=107) and the malignant lesion group (n=91). All patients underwent ultrasound-guided FNAC, and expression of BRAF gene was detected by real-time fluorescence quantitative polymerase chain reaction. The value of FNAC, BRAF gene detection and combined detection in the differential diagnosis of benign and malignant thyroid tumors was analyzed by Kappa consistency test and receiver operating characteristic (ROC) curves. Results The nodules were mostly under envelope in the malignant lesion group, while in the benign lesion group, which were mostly located within glands (P<0.05). FNAC results showed that 62 cases with type II Bethesda, 26 cases with type III Bethesda, 29 cases with type IV Bethesda, 14 cases with type V Bethesda and 67 cases with type VI Bethesda. There were significant differences in diagnostic positive rates between FNAC, BRAF gene detection, combined detection and pathological examination (P<0.05). The area under ROC curve (AUC) of FNAC combined with BRAF gene detection for differentiating benign and malignant thyroid tumors was 0.871 (95%CI：0.816-0.914), sensitivity was 90.11%, specificity was 84.11% and Kappa value was 0.737. The AUC of FNAC diagnosis was 0.833 (95%CI: 0.774-0.882), sensitivity was 76.92%, specificity was 89.72% and Kappa value was 0.672. The AUC of BRAF gene detection was 0.829（95%CI：0.770-0.879), sensitivity was 78.02%, specificity was 87.85% and Kappa value was 0.663. Conclusion FNAC combined with BRAF gene detection can improve differential diagnosis efficiency for benign and malignant thyroid lesions, especially enhancing the diagnostic sensitivity.

Key words: thyroid tumor, ultrasonography, biopsy, fine-needle, proto-oncogene proteins B-raf

CLC Number:

R446.6

Figures/Tables 4

References 18

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组别		n	年龄/岁			性别（男/女）
良性病变组		107	42.68±6.26			39/68
恶性病变组		91	43.49±6.54			43/48
t或χ²			0.891			2.366
组别	BMI/ （kg/m²）			肿瘤直径/ cm	肿瘤位置（包膜下/腺体内）
良性病变组	22.97±4.18			1.34±0.33	11/96
恶性病变组	22.71±4.05			1.38±0.42	51/40
t或χ²	0.440			0.611	47.885^＊

组别		n	年龄/岁			性别（男/女）
良性病变组		107	42.68±6.26			39/68
恶性病变组		91	43.49±6.54			43/48
t或χ²			0.891			2.366
组别	BMI/ （kg/m²）			肿瘤直径/ cm	肿瘤位置（包膜下/腺体内）
良性病变组	22.97±4.18			1.34±0.33	11/96
恶性病变组	22.71±4.05			1.38±0.42	51/40
t或χ²	0.440			0.611	47.885^＊

筛查项目	筛查结果	n	病理检查
筛查项目	筛查结果	n	阳性	阴性
FNAC	阳性	81	70（86.42）	11（13.58）
	阴性	117	21（17.95）	96（82.05）
	χ²		90.349^＊
BRAF	阳性	84	71（84.52）	13（15.48）
	阴性	114	20（17.54）	94（82.46）
	χ²		79.410^＊
FNAC+BRAF 联合检测^#	阳性	99	82（82.83）	17（17.17）
	阴性	99	9（9.09）	90（90.91）
	χ²		108.364^＊

筛查项目	筛查结果	n	病理检查
筛查项目	筛查结果	n	阳性	阴性
FNAC	阳性	81	70（86.42）	11（13.58）
	阴性	117	21（17.95）	96（82.05）
	χ²		90.349^＊
BRAF	阳性	84	71（84.52）	13（15.48）
	阴性	114	20（17.54）	94（82.46）
	χ²		79.410^＊
FNAC+BRAF 联合检测^#	阳性	99	82（82.83）	17（17.17）
	阴性	99	9（9.09）	90（90.91）
	χ²		108.364^＊

指标		AUC		95%CI		敏感度/%		特异度/%
FNAC	0.833		0.774~0.882		76.92		89.72
BRAF	0.829		0.770~0.879		78.02		87.85
联合检测	0.871		0.816~0.914		90.11		84.11
指标		准确度/%		阳性预测值/%		阴性预测值/%		Kappa值
FNAC		83.84		86.42		82.05		0.672
BRAF		83.33		84.52		82.46		0.663
联合检测		86.87		82.83		90.91		0.737