中国超声甲状腺影像报告和数据系统联合BRAF^(V600E)基因检测在BSRTCⅢ类甲状腺结节诊断中的价值

Value of C-TIRADS combined with BRAF^(V600E)testing in the differential diagnosis of Bethesda system for reporting thyroid cytopathology category III thyroid nodules

目的探讨2020年中国超声甲状腺影像报告和数据系统(C-TIRADS)联合BRAF^(V600E)基因检测在甲状腺细胞病理学Bethesda报告系统(BSRTC)Ⅲ类结节良恶性鉴别诊断中的价值。方法回顾性分析2020年10月~2022年10月于我院行超声引导甲状腺细针穿刺活检细胞学结果为BSRTCⅢ类的124例患者共156个结节,所有结节均行C-TIRADS分类及BRAF^(V600E)基因检测,并均经手术病理证实。以手术病理结果为金标准,比较C-TIRADS、BRAF^(V600E)检测及二者联合在BSRTCⅢ类甲状腺结节中的诊断效能。结果156个BSRTCⅢ类甲状腺结节最终术后病理结果显示良性结节93个,恶性结节63个;BRAF^(V600E)基因突变阳性48个,阴性108个。C-TIRADS分类ROC曲线下面积为0.834(95%CI:0.765~0.902);C-TIRADS分类和BRAF^(V600E)基因检测鉴别诊断BSRTCⅢ类甲状腺结节良恶性的敏感度分别为73.0%、76.2%,特异性分别为88.2%、98.9%,阳性预测值分别为80.7%、97.9%,阴性预测值分别为82.8%、85.2%,准确度分别为82.1%、89.1%。二者联合诊断的敏感度、特异性、阳性预测值、阴性预测值、准确度分别为90.4%、96.8%、95.0%、93.8%、94.2%。与C-TIRADS、BRAF^(V600E)基因检测单独诊断相比,联合诊断具有较高的敏感度(χ^(2)=6.435,P=0.011;χ^(2)=4.629,P=0.032)和阴性预测值(χ^(2)=5.588,P=0.018;χ^(2)=3.875,P=0.049)。结论C-TIRADS超声分类和BRAF^(V600E)基因检测对BSRTCⅢ类甲状腺结节均有较高的诊断效能,两者联合运用可提高诊断的敏感度及阴性预测值,有助于BSRTCⅢ类甲状腺结节的鉴别诊断。

Objective To investigate the value of 2020 Chinese Thyroid Imaging Report and Data System(C-TIRADS)combined with BRAF^(V600E)testing in the differential diagnosis of benign and malignant category III nodules in Bethesda system for reporting thyroid cytopathology(BSRTC).Methods A total of 156 thyroid nodules in 124 patients with BSRTC categoryⅢwho underwent ultrasound-guided fine needle aspiration biopsy at the Second Affiliated Hospital of Fujian Medical University from October 2020 to October 2022 were selected.Each nodule underwent C-TIRADS classification and BRAF^(V600E)testing and was confirmed by histopathology.The diagnostic efficacy of C-TIRADS,BRAF^(V600E)testing,and their combination in BSRTC categoryⅢnodules were assessed according to histopathology findings.Results According to histopathology findings,93 benign nodules and 63 malignant nodules in 156 nodules,48 positive and 108 negative for BRAF^(V600E)testing.The area under the ROC curve of C-TIRADS classification was 0.834(95%CI:0.765-0.902).The sensitivities of C-TIRADS classification and BRAF^(V600E)testing were 73.0%and 76.2%,the specificity were 88.2%and 98.9%,the positive predictive value were 80.7%and 97.9%,the negative predictive value were 82.8%and 85.2%,the accuracy were 82.1%and 89.1%,respectively.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the two combined diagnosis were 90.4%,96.8%,95.0%,93.8%and 94.2%,respectively.The combination of two methods significantly increased the sensitivity(χ^(2)=6.435,P=0.011;χ^(2)=4.629,P=0.032)and negative predictive value(χ^(2)=5.588,P=0.018;χ^(2)=3.875,P=0.049)when compared with C-TIRADS and BRAF^(V600E)testing in BSRTC categoryⅢnodules.Conclusion C-TIRADS classification and BRAF^(V600E)testing have great diagnostic efficacy in BSRTC categoryⅢnodules,and the combination of two methods can improve the diagnostic sensitivity and negative predictive value,suggesting the great value in differentiating BSRTC categoryⅢnodules.