摘要目的 探讨超声造影(contrast‐enhanced ultrasound , CEUS)联合丝／苏氨酸特异性激酶(serine‐threonine‐threonine protein kinase , BRAF)基因V600E (BRAF V600E)突变检测对细胞学意义不明确类型结节的诊断价值.方法 回顾性分析129个甲状腺超声引导下细针穿刺意义不明结节的常规超声检查、 CEUS及BRAF V600E基因检测的资料,以BRAF V600E阳性和CEUS不均匀低增强等表现作为甲状腺结节恶性诊断标准,并与术后病理学结果做对照,绘制 ROC曲线,比较CEUS 、 BRAF V600E基因检测及 CEUS 联合BRAF V600E 基因检测对该类结节良恶性的鉴别诊断价值.结果CEUS 、 BRAF V600E基因检测对细针穿刺细胞学意义不明确结节诊断良恶性的敏感性、特异性、准确性分别为86 .7%、 83 .3%、 85 .3% 和 72 .0%、 100%、 83 .7%. CEUS对细针穿刺细胞学意义不明确结节诊断良恶性的敏感性和准确性高于BRAF V600E 基因检测,差异有统计学意义(均 P ＜0 .001) ,而其特异性低于BRAF V600E ( P ＜0 .001) .两种方法联合诊断该类结节良恶性的敏感性、特异性、准确性分别为94 .7%、 83 .3%、 89 .9%,联合诊断效率最高,差异有统计学意义( P ＜0 .001) ,其ROC曲线下面积(AUC)高于BRAF V600E基因检测及CEUS检查(0 .951 对 0 .860 、 0 .901 ) .结论 CEUS联合BRAF V600E基因检测有助于提高鉴别甲状腺超声引导下细针穿刺意义不明结节病灶良恶性的准确性.

abstractsTo evaluate the diagnostic efficacies of contrast‐enhanced ultrasound ( CEUS ) combined with BRAF V600E mutation detection in ultrasound‐guided fine‐needle aspiration cytology of thyroid nodules with atypia of undetermined significance . Methods A total of 129 thyroid nodules underwent the examinations of CEUS and BRAF V 600E mutation were analyzed retrospectively . With surgical pathology as the gold standard ,ROC curve was used to investigate the diagnostic values of CEUS , BRAF V600E and the combination of the two methods . Results T he sensitivity ,specificity and accuracy of CEUS and BRAF V600E gene detection for thyroid nodules with atypia of undetermined significance diagnosed by ultrasound‐guided fine‐needle aspiration biopsy were 86 .7% ,83 .3% ,85 .3% and 72 .0% , 100% ,83 .7% ,respectively . The sensitivity and accuracy of CEUS were higher than those of BRAF V 600E gene detection ( all P ＜ 0 .001 ) ,however its specificity was lower than BRAF V 600E with statistically significance( P ＜ 0 .001 ) ,those of the combined test of CEUS and BRAF V600E mutation analysis were 94 .7% ,83 .3% ,89 .9% ,respectively . T he combination of two methods had the highest diagnostic efficacy , with statistically difference ( P ＜0 .001) ,and the area under the ROC curve ( AUC) was higher than that for each test ( 0 .951 vs 0 .860 vs 0 .901 ) . Conclusions T he combined test of CEUS and BRAF V600E mutation has a higher diagnostic efficacy for cytologically indeterminate thyroid nodules compared with CEUS or BRAF V600E mutation alone .