山东医药

目的 分析甲状腺穿刺活检联合BRAF V600E基因检测在甲状腺乳头状癌（PTC）诊断中的应用价值。方法 回顾性纳入接受甲状腺手术治疗的293例甲状腺结节患者，术前行甲状腺穿刺活检及BRAF V600E基因检测，以术中病理结果为金标准，采用配对4格表评估甲状腺穿刺活检、BRAF V600E基因检测及二者联合对PTC的诊断效能。用Logistic回归法构建穿刺活检联合BRAF V600E基因检测诊断PTC模型。结果 293例患者术中病理诊断为PTC 283例、非PTC 10例。283例病理确诊PTC患者中，甲状腺穿刺活检结果为PTC 241例、非PTC 42例，穿刺活检阳性率85.61%;BRAF V600E基因检测结果为PTC 280例、非PTC 3例，穿刺活检阳性率98.94%。与甲状腺穿刺活检比较，BRAF V600E基因检测诊断PTC的阳性率高（P<0.05）。甲状腺穿刺活检诊断PTC的准确度、灵敏度、特异度分别为85.7%、85.2%、100%;BRAF V600E基因检测诊断PTC的准确度、灵敏度、特异度分别为99.0%、98.9%、100%；二者联合检测诊断PTC的准确度、灵敏度、特异度分别为100%、100%、100%。甲状腺穿刺活检联合BRAF V600E基因诊断PTC模型为Logit(P/1-P)=-0.147+1.165×穿刺活检涂片结果 +1.431×BRAF V600E基因检测结果，甲状腺穿刺活检和BRAF V600E基因检测诊断PTC LogP型联合模型总分为181分。结论 甲状腺穿刺活检、BRAF V600E基因检测联合在PTC诊断中的应用价值较高。

Objective To analyze the application value of thyroid biopsy combined with BRAF V600E gene detection in the diagnosis of papillary thyroid carcinoma(PTC). Methods A retrospective study was conducted on 293 patients with thyroid nodules who underwent thyroid surgery. Preoperative thyroid biopsy and BRAF V600E gene testing were performed, and intraoperative pathological results were used as the gold standard. A paired four grid table was used to evaluate the diagnostic efficacy of thyroid biopsy, BRAF V600E gene testing, and their combination for PTC. Logistic regression was used to construct a diagnostic PTC model combining biopsy and BRAF V600E gene testing. Results Among 293 patients in the intraoperative pathological diagnosis, there were 283 cases of PTC and 10 cases of non-PTC. Among 283 pathologically diagnosed PTC patients, 241 cases were diagnosed with PTC and 42 cases were diagnosed with non-PTC through thyroid biopsy, with a positive rate of 85. 61%; the BRAF V600E gene test results showed 280 cases of PTC and 3 cases of non-PTC, with a positive rate of 98. 94% in biopsy. Compared with thyroid biopsy, BRAF V600E gene detection in diagnosis of PTC had a higher positive rate(P<0. 05). The accuracy, sensitivity, and specificity of thyroid biopsy in diagnosing PTC were 85. 7%, 85. 2%, and 100%, respectively; the accuracy, sensitivity, and specificity of BRAF V600E gene testing for diagnosing PTC were 99. 0%, 98. 9%, and 100%, respectively; the accuracy, sensitivity, and specificity of the combined detection and diagnosis of PTC were 100%, 100%, and 100%, respectively. The diagnostic model of PTC using biopsy combined with BRAF V600E was Logit(P/1-P)=-0. 147+1. 165 × biopsy smear results+1. 431 × BRAF V600E gene detection results. The total score of the LogP type combined model of biopsy smear and BRAF V600E gene detection in diagnosing PTC was 181 points. Conclusion The combination of thyroid biopsy and BRAF V600E gene testing has high diagnostic value in PTC.