整合TBSRTC分类和BRAFV600E测试用于贝塞斯达III甲状腺结节的精确管理:基于世卫组织第5版的研究,突出了亚型特定的诊断差异
1Department of Pathology, Deyang People's Hospital, Deyang, China.
Frontiers in oncology
|January 19, 2026
概括
贝塞斯达III型甲状腺结节具有核异型或直径小于1厘米,具有高恶性瘤风险. 结合BRAF V600E测试有助于诊断经典的乳头甲状腺癌,为不确定的结节提供管理信息.
科学领域:
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
- 细胞病理学 细胞病理学
背景情况:
- 通过超声导向细针吸收 (UG-FNA) 细胞学诊断为贝塞斯达III的甲状腺结节存在诊断不确定性.
- 调查这些结节的恶性潜力和分子标记物的实用性对于临床决策至关重要.
研究的目的:
- 评估与贝塞斯达III甲状腺结核相关的恶性瘤风险.
- 为了评估联合BRAFV600E突变测试的意义.
- 开发一个临床算法,整合贝塞斯达III结节的细胞形态学和分子特征.
主要方法:
- 对10839名具有UG-FNA结果的患者进行了回顾性分析,重点关注180名贝塞斯达III结节,并进行了组织学随访.
- 在来自101个结节的细胞块上进行的BRAF V600E突变测试.
- 用于识别恶性瘤预测因子的单变和多变逻辑回归;评估BRAFV600E测试的诊断价值.
主要成果:
- 在62.2%的贝塞斯达III结节中发现了恶性瘤,主要是乳头甲状腺癌 (PTC).
- 结节大小小于1厘米和"核异型"子类别是恶性瘤的独立预测因素 (OR = 121.854).
- BRAF V600E测试显示,经典PTC的高灵敏度 (90.2%) 和特异性 (100%),但毛囊变异PTC的灵敏度较低 (40%).
结论:
- 直径小于1厘米的贝塞斯达III结节或"核异型"子类别表明恶性风险高.
- 术前的BRAF V600E测试对于经典的PTC是有价值的,但对于FVPTC则不那么重要.
- 综合细胞形态学和BRAF测试的风险分层算法可以减少未确定甲状腺结节的不必要手术.
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