超声TI-RADS分类联合BRAF^(V600E)基因检测在BSRTCⅢ类甲状腺结节中的意义

Significance of ultrasound thyroid imaging reporting and data system classification combined with BRAF^(V600E) gene detection in BSRTCⅢthyroid nodules

目的探索甲状腺影像报告与数据系统(TI-RADS)联合BRAF^(V600E)对甲状腺细胞病理学Bethesda(BSRTC)分类为Ⅲ类结节的诊断意义。方法选取2018年8月至2020年8月于郑州大学第一附属医院行甲状腺超声引导下细针穿刺(US-FNA)且结果为BSRTCⅢ,共199个结节,以术后常规病理结果为金标准,比较TI-RADS、BRAF^(V600E)及两者联合对BSRTCⅢ类结节的诊断价值。结果199个Ⅲ类结节,术后病理:甲状腺乳头状癌77个,良性结节122个。TI-RADS分类为4b、4c或5类诊断BSRTCⅢ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为90.9%、74.5%、69.3%、92.9%、80.9%。BRAF^(V600E)诊断BSRTCⅢ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为89.6%、98.4%、97.2%、93.8%、95.0%。TIRADS 4b、4c、5类或BRAF^(V600E)阳性为BSRTCⅢ类结节恶性的诊断标准,其敏感度、特异度、阳性预测值、阴性预测值及准确性分别为98.7%、73.8%、70.4%、98.9%、83.4%。和TI-RADS比较,联合诊断具有较高的敏感(98.7%比90.9%,P<0.05)。和单独BRAF^(V600E)比较,联合诊断具有较高的敏感度(98.7%比89.6%,P<0.05)。结论TI-RADS和BRAF^(V600E)联合对BSRTCⅢ类结节具有良好的诊断效能,能提高BSRTCⅢ类甲状腺结节的恶性检出率,有效减少不必要的手术。

Objective To assess the diagnostic value of the thyroid imaging reporting and data system(TI-RADS)combined with BRAF^(V600E) testing in Bethesda System for Reporting Thyroid Cytopathology(BSRTC)categoryⅢnodules.Methods A total of 199 patients who underwent ultrasound-guided fine needle aspiration(US-FNA)at the First Affiliated Hospital of Zhengzhou University from August 2018 to August 2020 were selected.The diagnostic efficacy of TI-RADS,BRAF^(V600E) testing,and their combination was assessed according to histopathology findings.Results A total of 199 nodules from 199 patients were enrolled.According to histopathology findings,122 nodules were benign and 77 were papillary thyroid carcinoma.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of TI-RADS 4b,4c or 5 were 90.9%,74.5%,69.3%,92.9%and 80.9%,respectively.The sensitivity,specificity,PPV,NPV,and accuracy of BRAF^(V600E) mutation were 89.6%,98.4%,97.2%,93.8%and 95.0%,respectively.The sensitivity,specificity,PPV,NPV,and accuracy of the combination of TI-RADS and BRAF^(V600E) mutation were 98.7%,73.8%,70.4%,98.9%and 83.4%,respectively.As compared with TI-RADS alone,the combination showed significantly increased sensitivity(98.7%vs.90.9%,P<0.05).As compared with BRAF^(V600E) alone,the combination exhibited increased sensitivity(98.7%vs.89.6%,P<0.05).Conclusion Our findings suggest that the combination method has improved sensitivity and may have great value in differentiating BSRTCⅢthyroid nodules.