TIRADS、BSRTC与BRAF^V600E检测在甲状腺结节良恶性病变鉴别诊断中的比较研究

Comparison of diagnostic value of TIRADS, BSRTC, BRAF^V600E mutation detection and their combined use in differentiating thyroid nodules

目的：比较甲状腺影像报告和数据系统（ TIRADS ）、Bethesda 甲状腺细胞病理报告系统（ BSRTC）以及BRAF^V600E检测3种方法在甲状腺结节良恶性病变鉴别诊断中的价值,评估不同方法联合应用的意义。方法选取于南京医科大学第一附属医院行B超引导下细针穿刺活检（ FNAB）的128例甲状腺结节患者（128例结节）,予超声、细针穿刺细胞学（FNAC）检查及BRAF^V600E检测,超声及FNAC分别根据TIRADS、BSRTC进行诊断。构建受试者工作特征（ ROC）曲线评价各方法的诊断价值。结果 TIRADS的敏感性、特异性、ROC曲线下面积（AUC）分别为74.3%、84.5%、0.794。 BSRTC敏感性与TIRADS相同,但特异性（98.3%）较高。 BRAF^V600E检测的敏感性、特异性（82.9%、100.0%）均高于前两种方法,诊断价值最大（AUC=0.914）。不同方法联合应用均可以提高诊断的敏感性和准确率。其中,BSRTC联合BRAFV600E检测具有最高的准确率（98.4%）,较高的敏感性、特异性（98.6%、98.3%）,其AUC（0.984）显著高于其他方法（P〈0.05）。结论 BRAF^V600E检测在甲状腺结节良恶性病变鉴别诊断中的价值优于TIRADS和BSRTC。BSRTC联合BRAF^V600E检测具有最高的诊断效率。

Objective To compare the diagnostic efficiency of the thyroid imaging reporting and data system （TIRADS）, the Bethesda system for reporting thyroid cytopathology（BSRTC） and BRAF^V600E detection, and their combined use in the differentiation between benign and malignant thyroid nodules. Methods One hundred and twenty eight patients with 128 thyroid nodules who were scheduled for ultrasound-guided fine-needle aspiration biopsy （FNAB） were recruited for the study. All of them underwent ultrasound, fine-needle aspiration cytology（FNAC） examination, and BRAF^V600E detection. TIRADS and BSRTC systems were adopted to judge the ultrasound and FNAC results. The receiver operating characteristic curve was established to assess the diagnostic value of each method. Results The sensitivity, specificity, and AUC of TIRADS were 74. 3%, 84. 5%, and 0. 794, respectively. BSRTC had higher specificity（98. 3%） and equal sensitivity compared to TIRADS. The sensitivity, specificity, and AUC of BRAF^V600E detection were the highest ones among the three methods. Combinations of different methods could increase the diagnostic sensitivity and accuracy. The combination of FNAC and BRAF^V600E detection significantly increased the diagnostic efficiency（AUC=0. 984）, with sensitivity 98. 6% and specificity 98. 3%. Conclusions The diagnostic value of BRAF^V600E detection in the differentiation of benign and malignant thyroid nodules is better than both TIRADS and BSRTC, and the combination of FNAC and BRAF^V600E detection reaches the best diagnostic efficiency.