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BRAF(VE1)免疫组化联合细针穿刺细胞学在桥本甲状腺炎合并甲状腺结节诊断中的应用价值

The application value of BRAF(VE1) immunohistochemistry combined with fine needle aspiration cytology in the diagnosis of Hashimoto's thyroiditis with thyroid nodule

投稿时间：2025-04-13 修订日期：2025-06-23

DOI：

中文关键词: 细针穿刺细胞学甲状腺结节桥本甲状腺炎 BRAF(VE1) 诊断应用价值

英文关键词:fine needle aspiration cytology thyroid nodules Hashimoto's thyroiditis BRAF(VE1) diagnosis application value

基金项目:

作者	单位	邮编
高萍	日照市中心医院	276800
王萍萍^*	日照市中心医院	276800
张立平	日照市中心医院
韩洁	日照市中心医院
朱晓玲	日照市中心医院

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中文摘要:

[目的] 探讨BRAF(VE1)免疫组化联合细针穿刺细胞学（fine needle aspiration cytology，FNAC）检查在桥本甲状腺炎合并甲状腺结节诊断中的应用价值。[方法] 选取2021年1月-2023年12月于日照市中心医院行FNAC检查并手术切除的伴桥本甲状腺炎的甲状腺结节226例，按照Bethesda报告系统进行分类，利用剩余液基保存液制作细胞块，进行BRAF(VE1)免疫组化染色。依据组织病理结果，将选取病例分为恶性组和良性组，观察两组中BRAF(VE1)在细胞块免疫组化染色中的表达情况，并进行对比分析，以验证BRAF(VE1)免疫组化联合FNAC在桥本甲状腺炎合并甲状腺结节诊断中的应用价值。[结果] 术后常规病理164例为甲状腺乳头状癌，62例为桥本甲状腺炎增生结节。穿刺细胞学Bethesda报告系统分类 Ⅱ类23例（10.2％），Ⅲ类67例（29.6％），Ⅳ类2例（0.9％），Ⅴ类48例（21.2％），Ⅵ类86例（38.1％）。164例恶性组结节穿刺液基细胞块中BRAF(VE1)免疫组化染色阳性113例（68.9%），阴性51例（31.1%）；62例良性组结节穿刺液基细胞块中BRAF(VE1)免疫组化染色阳性0例，阴性62例（100%），在恶性组的表达率显著高于良性组（68.9% vs 0，P=0.000）。FNAC组、BRAF(VE1)免疫组化组和联合检测组的灵敏度分别为78.0%、68.9%、90.9%；准确度分别为81.4%、77.4%、90.7%；特异度分别为90.3%、100%、90.3%；联合检测组的灵敏度和准确度均高于单独检测组，差异均具有统计学意义（灵敏度P=0.001，P=0.000；准确度P=0.004，P=0.000）。 [结论] 细胞块BRAF(VE1)免疫组化联合FNAC检查在桥本甲状腺炎合并甲状腺结节诊断中的应用价值较大，能提高细胞学诊断甲状腺癌的灵敏度和准确度。

英文摘要:

[Objective] To investigate the application value of BRAF(VE1) immunohistochemistry combined with fine needle aspiration cytology (FNAC) examination in the diagnosis of Hashimoto's thyroiditis with thyroid nodules.[Methods] 226 cases of thyroid nodules with Hashimoto's thyroiditis undergoing FNAC examination and surgical resection at Rizhao Central Hospital from January 2021 to December 2023 were selected and classified according to the Bethesda reporting system. Cell blocks were prepared using residual liquid based preservation solution and subjected to BRAF(VE1) immunohistochemical staining. Based on the histopathological results, the selected cases were divided into malignant group and benign group. The expression of BRAF(VE1) in cell block immunohistochemistry staining was observed in both groups and compared to verify the application value of BRAF(VE1) immunohistochemistry combined with FNAC in the diagnosis of Hashimoto's thyroiditis with thyroid nodules.[Results] Postoperative routine pathology showed 164 cases of papillary thyroid carcinoma and 62 cases of Hashimoto's thyroiditis nodules.Among the 226 nodules,there were 23 cases (10.2%) of Bethesda class II,67 cases (29.6%) of class III, 2 cases (0.9%) of Class IV, 48 cases (21.2%) of Class V, and 86 cases (38.1%) of Class VI. Among 164 malignant nodules, 113 cases (68.9%) were positive for BRAF(VE1) immunohistochemical staining in the biopsy fluid based cell blocks, while 51 cases (31.1%) were negative; Among 62 benign nodules, there were 0 positive cases and 62 negative cases (100%) of BRAF(VE1) immunohistochemical staining in the biopsy fluid based cell blocks. The expression rate of BRAF(VE1) in the malignant group was significantly higher than that in the benign group (68.9% vs 0, P=0.000).The sensitivity of FNAC group, BRAF (VE1) immunohistochemistry group and combined detection group were 78.0%, 68.9% and 90.9%, respectively.The accuracies were 81.4%, 77.4% and 90.7%, respectively.The specificity was 90.3%, 100% and 90.3%, respectively.. The sensitivity and accuracy of the combined detection group were higher than those of the individual detection group, and the differences were statistically significant (sensitivity P=0.001, P=0.000; Accuracy P=0.004, P=0.000).[Conclusion] The application value of cell block BRAF(VE1) immunohistochemistry combined with FNAC in the diagnosis of Hashimoto's thyroiditis with thyroid nodules is significant, as it can improve the sensitivity and accuracy of cytological diagnosis of thyroid cancer.

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