To evaluate the diagnostic value of the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) combined with BRAF V600E mutation testing in differentiating benign and malignant Bethesda System for Reporting Thyroid Cytopathology (BSRTC) category Ⅲ nodules of different sizes. Methods A retrospective analysis was performed on the clinical data of 161 patients (161 nodules) diagnosed as BSRTC category Ⅲ by fine-needle aspiration (FNA) at The First Affiliated Hospital of Zhengzhou University between March 2020 and November 2023. According to the maximum diameter, patients were divided into a ≤10 mm group (n=125) and a >10 mm group (n=36). Postoperative histopathology was used as the gold standard. Receiver operating characteristic (ROC) curves were plotted to compare the diagnostic performance of C-TIRADS, BRAF V600E testing, and their combination for BSRTC category Ⅲ nodules of different sizes. Results Postoperative pathology revealed 108 malignant and 53 benign nodules. In the ≤10 mm group, the sensitivity, specificity, and accuracy of C-TIRADS were 72.6%, 86.7%, and 76.0%, respectively; those of BRAF V600E testing were 79.0%, 100.0%, and 84.0%, respectively; and those of the combined method were 91.6%, 86.7%, and 90.4%, respectively. Compared with C-TIRADS or BRAF V600E testing alone, the combined method significantly improved sensitivity (P<0.001, P=0.002) and accuracy (P<0.001, P<0.001), and its diagnostic efficacy was superior to C-TIRADS alone (AUC: 0.944 vs. 0.796, P=0.003). In the >10 mm group, the sensitivity, specificity, and accuracy of C-TIRADS were 84.6%, 91.3%, and 88.9%, respectively; those of BRAF V600E testing were 61.5%, 100.0%, and 86.1%, respectively; and those of the combined method were 84.6%, 91.3%, and 88.9%, respectively. The diagnostic performance of the combined method showed no significant difference compared with C-TIRADS or BRAF V600E testing alone (P>0.05). Conclusion C-TIRADS combined with BRAF V600E mutation testing provides better diagnostic efficacy for BSRTC category Ⅲ nodules with a maximum diameter of ≤10 mm and helps improve diagnostic accuracy in small BSRTC category Ⅲ nodules.
Key words
thyroid nodule /
Chinese thyroid imaging reporting and data system /
BRAF V600E mutation /
combined diagnostic efficacy
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