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

Diagnostic Value of BRAF^V600E Gene, Ultrasound and BMI in Malignant Thyroid Nodules with TI-RADS Category 3 and Above

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。

Abstract

Objective To investigate the diagnostic value of BRAF^V600E gene 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^V600E gene mutation analysis, ultrasonographic characteristics, and BMI demonstrates clinical value in differentiating benign from malignant thyroid nodules classified as TI-RADS category 3 or higher.

关键词

超声 / 体质量指数 / BRAF^V600E基因 / 甲状腺结节 / 危险因素

Key words

ultrasound / BMI / BRAF^V600E / thyroid nodules / risk factors

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基金资助

安徽高校自然科学研究项目（KJ2021ZD0033）