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常规超声特征及BRAFV600E基因突变与甲状腺乳头状癌颈部淋巴结转移的相关性
作者:兰雨 宋青 金壮 张颖 林林 罗渝昆 
单位:300071  天津 南开大学医学院影像医学与核医学专业(兰雨、罗渝昆) 100853  北京 解放军总医院第一医学中心超声科(兰雨、宋青、金壮、张颖、林林、罗渝昆) 
关键词:甲状腺乳头状癌 超声特征 BRAFV600E基因 颈部淋巴结 转移 
分类号:R736.1
出版年,卷(期):页码:2019,44(9):757-762
摘要:

 [摘要]  目的  探讨常规超声特征及BRAFV600E基因突变与甲状腺乳头状癌颈部淋巴结转移的相关性。方法  选择2018112月在解放军总医院第一医学中心行甲状腺腺体切除及颈部淋巴结清扫术的甲状腺乳头状癌患者107例为研究对象,其中转移组56例,非转移组51例。对两组患者进行超声检查及BRAFV600E基因突变检测,分析比较两组患者各项指标,包括性别、年龄、病灶位置(上中下极)、是否靠近被膜、是否靠近峡部、病灶位于左/右叶、病灶数目、最大径线、纵横比、边界、形态、内部回声、内部成分、周围声晕、钙化、钙化形态、血流特征、是否合并桥本氏病、BRAFV600E基因突变情况。对性别、年龄、病灶是否靠近被膜、病灶是否靠近峡部、最大径线、病灶形态、含有钙化、周围声晕、钙化形态、BRAFV600E基因突变进行logistic回归分析。利用logistic回归分析方法,构建甲状腺乳头状癌患者颈部淋巴结转移的预测模型,并评价其预测效能。结果  两组患者性别、年龄、病灶最大径线、是否靠近被膜、是否靠近峡部、病灶形态、声晕、钙化、钙化形态等指标比较差异有统计学意义(P<0.05)Logistic多因素回归分析结果显示,性别(OR=4.197)、年龄(OR=4.895)、病灶最大径线(OR=3.636)是甲状腺乳头状癌患者颈部淋巴结转移的危险因素(P<0.05)。利用logistic回归分析方法建立的预测模型为:Logistic(P)=–21.957+1.434×性别+1.588×年龄+ 1.291×最大径线。对预测模型进行效能检验显示,敏感度为75.00%,特异度为72.55%结论  BRAFV600E基因突变与甲状腺乳头状癌患者颈部淋巴结转移无相关性;年龄<55岁、男性、癌灶最大径线>10 mm时,应警惕其颈部淋巴结转移的风险。

 [Abstract]  Objective  To investigate the correlation of routine ultrasound features and BRAFV600E gene to the cervical lymph node metastasis (CLNM) of thyroid papillary carcinoma (PTC). Methods  A hundred and seven patients with thyroid papillary carcinoma who underwent thyroid gland resection and cervical lymph node dissection in the First Medical Center of Chinese PLA General Hospital from January to December 2018 were recruited as study subjects, including 56 patients in the metastatic group and 51 patients in the non-metastatic group. Ultrasound examination and BRAFV600E gene detection were performed, and the indicators obtained were compared between the two groups including gender, age, focus position (upper middle or inferior), close to the capsule or to the isthmus, focus located in the left or right lobes, single or multiple, maximum diameter, aspect ratio, boundary, shape, internal echo, internal components, peripheral halos, calcification, microcalcification, color Doppler features, Hashimoto's disease, and BRAFV600E gene mutation. Logistic regression analysis was conducted for gender, age, close to the capsule or to the isthmus, maximum diameter, shape, calcification, microcalcification, color Doppler features, Hashimoto's disease, and BRAFV600E gene mutation to establish a predictive model of cervical lymph node metastasis in patients with thyroid papillary carcinoma, and the predictive efficacy of the model was evaluated. Results  The results compared between the two groups showed that statistically significant differences existed in gender, age, maximum diameter of the lesion, close to capsule, close to isthmus, shape, acoustic halo, calcification and microcalcification (P<0.05). Logistic multivariate regression analysis showed that gender (OR=4.197), age (OR=4.895) and maximum diameter (OR=3.636) were risk factors for cervical lymph node metastasis in patients with thyroid papillary carcinoma (P<0.05). The prediction model established by logistic regression analysis was logistic (P)=–21.957+1.434×gender+1.588×age+1.291×maximum diameter. The efficiency test results of the prediction model showed that the sensitivity and specificity were up to 75.00% and 72.55% respectively. Conclusions  It is preliminarily confirmed that BRAFV600E gene mutation is not correlated with cervical lymph node metastasis in patients with thyroid papillary carcinoma. For male patients aged less than 55 years old, the risk of cervical lymph node metastasis should be on guard when the maximum diameter of the carcinoma is large than 10 mm.

基金项目:
国家自然科学基金(81771834);北京市科技计划课题(Z181100001718017)
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