Association Between Preoperative US, Elastography Features and Prognostic Factors of Papillary Thyroid Cancer With BRAFV600E Mutation
Association Between Preoperative US, Elastography Features and Prognostic Factors of Papillary Thyroid Cancer With BRAFV600E Mutation
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DOI：
10.3389/fendo.2019.00902
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发表时间：
2020-01-22
影响因子：
5.2
通讯作者：
Chen, Man
中科院分区：
文献类型：
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作者：
Xu, Jun-Mei;Chen, Yong-Jun;Chen, Man
目的：探讨US和弹性成像对BRAF（V600E）突变阳性组甲状腺乳头状癌（PTC）预后因素的预测价值。材料与方法：本前瞻性研究共纳入116例BRAF（V600E）突变合并ptc患者，术前采用US、US弹性成像（EI）、虚拟触摸组织成像（VTI）和虚拟触摸组织量化（VTQ）声辐射力脉冲（ARFI）成像进行评估。采用多因素logistic回归分析评估23个独立变量预测预后的影响因素。采用受试者工作特征（ROC）曲线分析评价诊断效果。结果：116例BRAF（V600E）突变PTC患者中有42例（36.2%）发生中央淋巴结转移（LNM）。9例（7.8%）和56例（48.3%）分别为外侧LNM和甲状腺外展（ETE）。在多因素logistic回归分析中，丰富的内部血流[比值比[OR]: 6.66]是中心性LNM的最佳预测因子，其次是男性（OR: 4.22）、无晕征（OR: 2.78）（均P < 0.05）。VTQ比值（OR: 1.57）是侧位LNM的唯一预测因子（P = 0.02）。丰富的内流（OR: 6.33）是影响ETE的最强预测因子，其次是男性（OR: 3.29）、晕征缺失（OR: 2.90）和VTQ比值（OR: 1.63）（均P < 0.05）。结论：ARFI影像VTQ比、US内血流丰富、无晕征是预测BRAF（V600E）突变PTC患者预后的因素。结合ARFI成像和US特征，特异性显著提高，有可能避免高危PTC患者不必要的治疗性颈部清扫。
Purpose: To investigate the value of US and elastography for predicting prognostic factors of papillary thyroid cancer (PTC) in the positive BRAF(V600E) Mutation group.Materials and Methods: A total of 116 BRAF(V600E) Mutation patients with PTCs were enrolled in this prospective study, who were preoperatively evaluated by US, US elasticity imaging (EI), and Virtual Touch tissue imaging (VTI) and Virtual Touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) imaging. Multivariate logistic regression analysis was performed to assess 23 independent variables for predicting prognostic factors. Diagnostic performance was evaluated with receiver operating characteristic (ROC) curve analysis.Results: Forty-two (36.2%) of 116 PTC patients with BRAF(V600E) Mutation had central lymph node metastasis (LNM). Nine (7.8%) and fifty-six (48.3%) had lateral LNM and extra-thyroidal extension (ETE), respectively. In multivariate logistic regression analyses, rich internal flow [odds ratio [OR]: 6.66] was the best predictor for central LNM, followed by male sex (OR: 4.22), halo sign absence (OR: 2.78) (all P < 0.05). VTQ ratio (OR: 1.57) was the only predictor for lateral LNM (P = 0.02). Rich internal flow (OR: 6.33) was the strongest predictor for ETE, followed by male sex (OR: 3.29), halo sign absence (OR: 2.90), and VTQ ratio (OR: 1.63) (all P < 0.05).Conclusion: VTQ ratio on ARFI imaging, rich internal flow and halo sign absence on US are the predicting prognostic factors in PTC patients with BRAF(V600E) Mutation. The specificities were significantly increased by combining ARFI imaging and US features, which has a potential to avoid unnecessary therapeutic neck dissection in the high-risk PTC patients.