ACR-TIRADS和C-TIRADS单独及联合BRAF(V600E)基因检测对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断效能比较

Value of ACR-TIRADS versus C-TIRADS and their combination with BRAF(V600E)gene detection in diagnosis of BethesdaⅢ/Ⅳ/Ⅴthyroid nodules

背景BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断一直是临床医师面临的挑战,BRAF(V600E)基因检测常用于术前评估,其特异度高,但敏感度低;美国放射学会和中华医学会超声分会分别提出了美国放射学会甲状腺影像报告和数据系统(American College of Radiology Thyroid Imaging Reporting and Data System,ACR-TIRADS)和中国甲状腺影像报告和数据系统(Chinese Thyroid Imaging Reporting and Data System,C-TIRADS);将TIRADS与BRAF(V600E)基因检测相结合,旨在提高BethesdaⅢ/Ⅳ/Ⅴ类结节的诊断率,并避免不必要的手术和穿刺活检。目的比较ACR-TIRADS与C-TIRADS对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断效能,并探讨BARF(V600E)检测的附加价值。方法纳入2020年1月—2023年7月于解放军总医院第一医学中心接受细针穿刺活检并行BRAF(V600E)基因检测的484例患者(484个甲状腺结节),以病理组织学为“金标准”,比较ACR-TIRADS、C-TIRADS单独及联合BRAF(V600E)基因检测对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断价值。结果两种超声分层系统中甲状腺结节的恶性风险随着分级的升高逐渐增加(趋势χ2检验,P均<0.001),ACR-TIRADS、C-TIRADS的最佳截断值分别为5类、4c类。BRAF(V600E)基因检测在不降低诊断特异度的基础上显著提高了ACR-TIRADS(0.809 vs 0.778,P<0.001)和C-TIRADS(0.815 vs 0.783,P<0.001)对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节良恶性的诊断效能。ACR-TIRADS与C-TIRADS单独及联合BRAF(V600E)基因检测的曲线下面积(area under the curve,AUC)差异无统计学意义(0.778 vs 0.783,P=0.755;0.809 vs 0.815,P=0.675),但C-TIRADS单独及联合BRAF(V600E)基因检测的敏感度(88.83%vs 83.90%,P<0.001;95.33%vs 90.13%,P<0.001)和准确度(84.50%vs 81.41%,P<0.001;89.67%vs86.36%,P<0.001)高于ACR-TIRADS单独及联合诊断,而ACR-TIRADS单独及联合诊断的特异度相等,均高于C-TIRADS(71.72%vs 67.68%,P<0.001)。结论BRAF(V600E)基因检测可以在不降低特异度的基础上显著提高ACR-TIRADS、C-TIRADS对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节良恶性的诊断性能,其中C-TIRADS单独及联合整体诊断性能最佳,在临床实践中具有一定的应用潜力。

Background The diagnosis of BethesdaⅢ/Ⅳ/Ⅴthyroid nodules has always been a challenge for clinicians.While BRAF(V600E)gene detection is commonly used for preoperative assessment,it exhibits high specificity but low sensitivity.The American college of radiology and the Chinese medical association ultrasound branch have respectively proposed the American college of radiology thyroid imaging reporting and data system(ACR-TIRADS)and the Chinese thyroid imaging reporting and data system(C-TIRADS).The combination of TIRADS with BRAF(V600E)gene detection aims to improve the diagnostic accuracy of BethesdaⅢ/Ⅳ/Ⅴthyroids nodules and reduce unnecessary surgical procedures and fine needle aspiration biopsies.Objective To compare the diagnostic value of American college of radiology thyroid imaging reporting and data system(ACR-TIRADS),Chinese thyroid imaging reporting and data system(C-TIRADS)in BethesdaⅢ/Ⅳ/Ⅴthyroid nodules,and explore the additional value of BRAF(V600E)gene detection.Methods This study included 484 thyroid nodules from 484 patients who underwent fine needle aspiration biopsies and BRAF(V600E)gene detection in the Chinese PLA General Hospital from January 2020 to July 2023.Taking histopathological diagnosis as the gold standard,the diagnostic value of ACR-TIRADS,C-TIRADS,and their combination with BRAF(V600E)gene detection in BethesdaⅢ/Ⅳ/Ⅴthyroid nodules was compared.Results In both ultrasound stratification systems,the malignant risk of thyroid nodules gradually increased with higher grades(all P for trend<0.001).The optimal cut-off values for ACR-TIRADS and C-TIRADS were 5 and 4c,respectively.BRAF(V600E)gene detection significantly improved the diagnostic performance of ACR-TIRADS(0.809 vs 0.778,P<0.001)and C-TIRADS(0.815 vs 0.783,P<0.001)for BethesdaⅢ/Ⅳ/Ⅴthyroid nodules without reducing diagnostic specificity.There was no statistically significant difference in the area under the curve(AUC)between ACR-TIRADS and C-TIRADS,whether assessed individually or in combination(0.783 vs 0.778,P=0.755;0.815 vs 0.809,P=0.675).However,C-TIRADS exhibited higher sensitivity(88.83%vs 83.90%,P<0.001;95.33%vs 90.13%,P<0.001)and accuracy(84.50%vs 81.41%,P<0.001;89.67%vs 86.36%,P<0.001)compared to ACR-TIRADS,either alone or in combination.Notably,the specificity of ACR-TIRADS,either alone or in combination was equal,and higher than that of C-TIRADS(71.72%vs 67.68%,P<0.001).Conclusion BRAF(V600E)gene detection significantly enhances the diagnostic performance of ACR-TIRADS and C-TIRADS for BethesdaⅢ/Ⅳ/Ⅴthyroid nodules without compromising specificity.Whether used alone or in combination with BRAF(V600E)gene detection,C-TIRADS exhibits the best overall diagnostic performance,demonstrating promising clinical utility.