根据基于BRAFV600E突变状态的治疗指南的甲状腺结节手术结果

Surgical Results of Thyroid Nodules according to a Management Guideline Based on the BRAF^V600E Mutation Status

根据基于BRAF^V600E突变状态的治疗指南的甲状腺结节手术结果

Context: In Korea, where PTC comprises about 90?95% of the reported thyroid cancers, the prevalence of BRAF^V600E mutation in papillary thyroid carcinoma (PTC) is above 80%. 海南医学院附属医院内分泌科王新军

背景： 在韩国，PTC的约占甲状腺癌的90-95％，在乳头状甲状腺癌（PTC）BRAF^V600E 突变发生率在80％以上。
Objective: We analyzed the surgical result according to a management guideline based on the BRAF^V600E mutation status of thyroid nodules.

目的：分析按照甲状腺结节BRAF ^V600E突变状态为基础的诊治指南手术的结果。

Design: A total of 865 thyroid nodules were prospectively analyzed for their cytology and BRAF^V600E mutation status by pyrosequencing. For the patients who had a diagnosis of atypical cells of undetermined significance (ACUS), we recommended surgery when there was positivity for BRAF^V600E mutation or the nodules were clinically suspicious.

设计：  通过焦磷酸测序对865例甲状腺结节患者的细胞学和BRAF^V600E突变状态。对无明确诊断意义的非典型细胞的病人（ACUS），当存在BRAF^V600E突变阳性或临床可疑的结节时，我们建议进行手术。
Results: Among 865 cases, 504, 141, 54, 140, 10, and 16 were diagnosed as benign, ACUS, suspicious for malignancy, malignant, suspicious for follicular neoplasm, and nondiagnostic, respectively. None of the 504 benign, 45 (31.9%) of the 141 ACUS, 46 (85.2%) of the 54 suspicious for malignancy, 129 (92.1%) of the 140 malignant, and one (10%) of the 10 suspicious for follicular neoplasm cases showed BRAF^V600E mutation. Surgery was recommended to all 45 patients with BRAF^V600E mutation-positive ACUS nodules; among them, 30 patients underwent surgery, 29 had PTC, and one had nodular hyperplasia. All the patients diagnosed as suspicious for malignancy or malignant were advised to undergo an operation, and they turned out to have PTCs regardless of their BRAF^V600E mutation status.

结果： 在865例患者中，分别有504、141、54、140、10和16例诊断为良性、无明确诊断意义的非典型细胞、可疑恶性肿瘤、恶性、滤泡性肿瘤可疑和无法确诊。504例良性结节中无1例、141例无明确诊断意义的非典型细胞中有45例（31.9％）、54例可疑恶性肿瘤中有46例（85.2％）、140例恶性肿瘤中有129例（92.1％）、10例可疑滤泡肿瘤中有1例（10％）为BRAF ^V600E突变。对所有45 例BRAF ^V600E突变阳性ACUS结节的患者均建议了手术；其中，30例患者接受了手术，29例为PTC，1例为结节性增生。所有诊断为可疑恶性肿瘤或恶性肿瘤的患者均建议手术，结果证实为PTC，不论其BRAF ^V600E突变状态如何。
Conclusions: We found that performing BRAF^V600E mutation analysis on the fine-needle aspiration biopsy specimens was of great help to make a therapeutic decision for thyroid nodules when the fine-needle aspiration biopsy results were equivocal.

结论：  我们发现，当细针穿刺活检结果模棱两可时，对细针穿刺活检标本进行BRAF^V600E突变分析对制定甲状腺结节治疗决策有很大帮助。

J Clin Endocrinol Metab 2011 96: 658-664