实时剪切波弹性成像杨氏模量最大值诊断甲状腺乳头状癌BRAF V600E基因突变的价值

目的:探究实时剪切波弹性成像（SWE）杨氏模量最大值诊断甲状腺乳头状癌（PTC）鼠类肉瘤滤过性毒菌致癌同源体B1（BRAF）V600E基因突变的价值。方法:回顾性分析2018年1月~2019年6月宿迁市第一人民医院收治的110例PTC患者共124个结节的临床及超声影像学资料。患者经病理学检查均确诊为PTC，并完成了BRAF V600E基因检测以及SWE检查，临床资料完整。通过比较V600E基因突变型与野生型PTC的SWE检查结果，并绘制患者Emax值的ROC曲线，分析Emax值对PTC患者BRAF V600E基因突变的诊断效能。结果:BRAF基因检测结果显示:124个PTC结节BRAF基因检测V600E野生型共37个，V600E突变型共87个。野生型PTC结节的SWE图像多以蓝色为主，而突变型主要表现为红橙相间彩色混杂的图像。突变组PTC结节Emax、Emean、Eratio值均明显大于野生组，比较差异具有统计学意义（P<0.05），ROC曲线分析显示:Emax值诊断V600E突变的AUC=0.846>0.5（95%CI:0.808~0.885, P<0.01）；Cut-off值为43.65 kPa，此时敏感度为91.45%，特异性为68.23%。以Emax≥43.65 kPa为临界值对124个结节进行诊断，结果显示:SWE诊断PTC结节为V600E基因突变型90个，野生型34个，正确率为86.29%；SWE诊断结果与基因检测结果一致性显著（Kappa值=0.665, P<0.01）。结论:PTC BRAF V600E基因突变型与野生型的SWE影像学特征具有明显差异，应用SWE的Emax值诊断PTC结节V600E基因突变的正确率和敏感性均较高，诊断价值显著，值得在临床上推广应用。

Diagnostic value of the maximum Youngs modulus of real-time shear wave elastography in BRAF V600E gene mutation in papillary thyroid carcinoma

Abstract: Objective To investigate the value of the maximum Youngs modulus (Emax) of real-time shear wave elastography (SWE) in the diagnosis of the mutation of BRAF V600E gene in papillary thyroid carcinoma (PTC). Methods The clinical and ultrasonographic data of 124 nodules from 110 PTC patients who were admitted to Suqian First Hospital from January 2018 to June 2019 were analyzed retrospectively. The patients were diagnosed with PTC by pathological examination and underwent BRAF V600E gene test and SWE, having complete clinical data. The SWE results of V600E gene mutant PTC were compared with those of wild-type PTC, and then the ROC curve of Emax was plotted for analyzing the diagnostic efficacy of Emax for the BRAF V600E gene mutation in PTC patients. Results BRAF gene test results revealed that out of 124 PTC nodules, 37 were V600E wild-type and 87 were V600E mutant. The SWE images of wild-type PTC nodules were mostly blue, while the SWE images of mutant PTC nodules were mainly characterized by red and orange. The Emax, Emean and Eratio of the mutant PTC nodules were significantly higher than those of wild-type PTC nodules, with statistical differences (P<0.05). The ROC curve analysis showed that the diagnosis of V600E mutation by Emax had an AUC=0.846>0.5 (95%CI: from 0.808 to 0.885, P<0.01). Cut-off value was 43.65 kPa, and at this time, the sensitivity and the specificity were 91.45% and 68.23%. With Emax≥43.65 kPa as the critical value, 124 nodules were diagnosed, and the diagnostic results by SWE showed that there were V600E gene mutants in 90 PCT nodules and wild-type in 34 PCT nodules, with a diagnostic?ccuracy of 86.29%. There was a significant consistency between SWE diagnosis and genetic test results (Kappa=0.665, P<0.01). Conclusion The SWE imaging features of BRAF V600E gene mutant PTC are significantly different from those of wild-type. The Emax of real-time SWE can achieve a high accuracy and sensitivity in the diagnosis of V600E gene mutation in PTC nodules, with significant diagnostic value and worthy of clinical application.