BRAFV600E、超声及BMI对TI-RADS 3类及以上甲状腺恶性结节的诊断价值

摘要/Abstract

摘要： 目的研究BRAF^V600E基因突变、超声和BMI对TI-RADS 3类及以上甲状腺结节（TN）良恶性的诊断价值。方法回顾性分析2022年10月—2023年12月就诊于安徽医科大学附属巢湖医院的203例TI-RADS 3类及以上患者,比较不同诊断方法的特异度、敏感度及其他指标,并通过Logistic回归探讨恶性结节的危险因素。结果恶性组超声表现（低回声、实性、边界模糊等）、体质量指数（BMI）、BRAF^V600E突变比例高于良性组（P<0.05）;3种检查结合的敏感度（74.2%）、阴性预测值（88.8%）及诊断效能（0.821）均优于单一方法（P<0.05）;Logistic回归分析显示,BMI≥28 kg·m^-2、低回声、包膜侵犯及BRAF^V600E突变为恶性结节的危险因素（P<0.05）。结论 BRAF^V600E基因、超声特点及BMI结合使用在鉴别TI-RADS 3类及以上TN的良恶性方面具有临床价值。

关键词: 超声, 体质量指数, BRAF^V600E基因, 甲状腺结节, 危险因素

Abstract: Objective To investigate the diagnostic value of BRAF^V600Egene mutation, ultrasonographic features, and body mass index (BMI) in distinguishing benign from malignant thyroid nodules classified as TI-RADS category 3 or higher. Methods A retrospective analysis was conducted on 203 patients with TI-RADS category 3 or higher nodules who were diagnosed and treated at the Chaohu Hospital Affiliated to Anhui Medical University from October 2022 to December 2023. The specificity, sensitivity, and other diagnostic indicators of different diagnostic methods were compared. Logistic regression analysis was employed to identify risk factors for malignant nodules. Results The malignant group exhibited a higher proportion of features on ultrasonography (e.g., hypoechoicity, solid composition, ill-defined margins), a higher BMI, and a greater rate of BRAF^V600E mutation compared to the benign group (P<0.05). The combination of all three examinations demonstrated superior sensitivity (74.2%), negative predictive value (88.8%), and overall diagnostic efficacy (0.821) compared to any single method alone (P<0.05). Logistic regression analysis identified a BMI ≥ 28 kg·m^-², hypoechoicity, capsular invasion, and BRAF^V600E mutation as significant risk factors for malignant nodules (P<0.05). Conclusion The combination of BRAF^V600Egene mutation analysis, ultrasonographic characteristics, and BMI demonstrates clinical value in differentiating benign from malignant thyroid nodules classified as TI-RADS category 3 or higher.

Key words: ultrasound, BMI, BRAF^V600E, thyroid nodules, risk factors

中图分类号:

R736.1

余晨帆, 窦家庆. BRAF^V600E、超声及BMI对TI-RADS 3类及以上甲状腺恶性结节的诊断价值[J]. 承德医学院学报, 2025, 42(5): 383-387.

YU Chen-fan, DOU Jia-qing. Diagnostic Value of BRAF^V600E Gene, Ultrasound and BMI in Malignant Thyroid Nodules with TI-RADS Category 3 and Above[J]. Journal of Chengde Medical University, 2025, 42(5): 383-387.

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链接本文: http://tougao.cdmc.edu.cn:8088/CN/

http://tougao.cdmc.edu.cn:8088/CN/Y2025/V42/I5/383

参考文献

[1] Chen DW, Lang BHH, McLeod DSA, et al. Thyroid cancer[J]. Lancet, 2023, 401(10387): 1531-1544.
[2] Volante M, Lam AK, Papotti M, et al.Molecular Pathology of Poorly Differentiated and Anaplastic Thyroid Cancer: What Do Pathologists Need to Know?[J]. Endocr Pathol, 2021, 32(1): 63-76.
[3] 刘晓云,徐书杭,邬宏恂,等. 加强甲状腺结节细针穿刺规范化管理[J]. 中华内分泌代谢杂志,2019,35(10):819-824.
[4] Silva RRE, Borges VRA, Jardim AGS, et al. Correlation between thyroid fine needle aspiration and pathological examination: a 10 year retrospective study[J]. Einstein (Sao Paulo), 2023, (21): eAO0418.
[5] Şahin M, Oguz A, Tuzun D, et al.Effectiveness of TI-RADS and ATA classifications for predicting malignancy of thyroid nodules[J]. Adv Clin Exp Med, 2021, 30(11): 1133-1139.
[6] 吴墅,赵佳琦. TI-RADS分类联合细针穿刺活检术对甲状腺结节的诊断价值[J]. 同济大学学报(医学版),2022,43(2):224-228.
[7] 中华医学会内分泌学分会,中华医学会外科学分会甲状腺及代谢外科学组,中国抗癌协会头颈肿瘤专业委员会,等. 甲状腺结节和分化型甲状腺癌诊治指南(第二版)[J]. 中华内分泌代谢杂志,2023,39(3):181-226.
[8] 罗丹,韩艳波,李双,等. 甲状腺细针穿刺不同细胞学标本保存方法对BRAF V600E基因突变检测的影响[J]. 现代肿瘤医学,2023,31(5):835-838.
[9] Chung J, Lee YJ, Choi YJ, et al.Clinical applications of Doppler ultrasonography for thyroid disease: consensus statement by the Korean Society of Thyroid Radiology[J]. Ultrasonography, 2020, 39(4): 315-330.
[10] 徐华,马哲. 彩色多普勒超声诊断甲状腺良恶性结节的超声特征及诊断效能[J]. 中国临床研究,2023,36(11):1645-1648.
[11] Pan XF, Wang L, Pan A.Epidemiology and determinants of obesity in China[J]. Lancet Diabetes Endocrinol, 2021, (9): 373-392.
[12] He Q, Sun H, Li F, et al.Obesity and risk of differentiated thyroid cancer: A large-scale case-control study[J]. Clin Endocrinol (Oxf), 2019, 91(6): 869-878.
[13] 褚晓秋,徐书杭,王雅琳,等. 甲状腺细胞病理学Bethesda报告系统用于甲状腺结节诊断临床研究[J]. 中国实用内科杂志,2017,37(5):452-455.
[14] Alhassan R, Al Busaidi N, Al Rawahi AH, et al.Features and diagnostic accuracy of fine needle aspiration cytology of thyroid nodules: retrospective study from Oman[J]. Ann Saudi Med, 2022, 42(4): 246-251.
[15] Yaprak Bayrak B, Eruyar AT.Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology[J]. BMC Endocr Disord, 2020, 20(1): 48.
[16] Pizzato M, Li M, Vignat J, et al.The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and mortality rates in 2020[J]. Lancet Diabetes Endocrinol, 2022, 10(4): 264-272.
[17] 陈彦林,陈雪丹,田慧萍,等. 高频超声联合彩色多普勒超声对甲状腺良/恶性结节的诊断效果[J]. 影像研究与医学应用,2021,5(22):129-130,132.
[18] Tan H, Li Z, Li N, et al.Thyroid imaging reporting and data system combined with Bethesda classification in qualitative thyroid nodule diagnosis[J]. Medicine (Baltimore), 2019, 98(50): e18320.
[19] 赵媛,赵永刚,张春芳,等. 超声、细针穿刺细胞学及BRAF(V600E)基因对甲状腺结节的诊断价值[J]. 实用医学杂志,2020,36(24):3420-3424.
[20] Parad MT, Fararouei M, Mirahmadizadeh AR, et al.Thyroid cancer and its associated factors: A population-based case-control study[J]. Int J Cancer, 2021, 149(3): 514-521.
[21] Roskoski R Jr.Targeting ERK1/2 protein-serine/threonine kinases in human cancers[J]. Pharmacol Res, 2019, (142): 151-168.
[22] Belladelli F, Montorsi F, Martini A, et al.Metabolic syndrome, obesity and cancer risk[J]. Curr Opin Urol, 2022, 32(6): 594-597.
[23] Huang J, Shi H, Song M, et al.Surgical Outcome and Malignant Risk Factors in Patients With Thyroid Nodule Classified as Bethesda Category Ⅲ[J]. Front Endocrinol (Lausanne), 2021, (12): 686849.