Diagnostic value of thyroid imaging report and data system combined with BRAF V600E mutation detection for thyroid fine needle puncture cytological uncertain nodules / 肿瘤研究与临床

Objective:To investigate the diagnostic value of thyroid imaging report and data system (TIRADS) combined with BRAF V600E mutation detection in differentiating uncertain thyroid nodules by using fine needle aspiration cytology (FNAC), and to analyze the role of TIRADS classification in screening the nodules needed to be routinely detected for BRAF V600E mutation.Methods:The clinicopathological data of 337 thyroid nodules patients diagnosed with TIRADS classification, FNAC Bethesda classification, BRAF V600E mutation detection and postoperative histopathology from the Second Hospital of Hebei Medical University between January 2018 and August 2021 were retrospectively analyzed. The role of TIRADS classification, FNAC Bethesda classification and BRAF V600E mutation detection alone and the combined detection in the differentiation of benign and malignant thyroid nodules was also analyzed.Results:The postoperative histopathological result was regarded as the gold standard. The sensitivity of TIRADS classification, FNAC Bethesda classification and BRAF V600E mutation for thyroid cancer diagnosis was 76.0%, 88.1% and 80.4% respectively, and the corresponding specificity was 84.0%, 96.0% and 100.0%, respectively. Histologically, 37 (62.7%) of 59 nodules with FNAC uncertainty were malignant nodules after the surgery. The sensitivity and accuracy of BRAF V600E mutation detection in the diagnosis of FNAC uncertain nodules were 51.4% and 69.5%, respectively, while the sensitivity and accuracy of BRAF V600E mutation detection combined with TIRADS classification were 86.5% and 84.7%, respectively. The sensitivity and accuracy of BRAF V600E mutation detection combined with TIRADS classification were both improved ( P values were 0.002 and 0.049, respectively). The positive rate of BRAF V600E mutation in thyroid nodules increased step by step with the rise of risk degree in TIRADS classification, and the type 3 cases were lower than those in type 4a cases [14.3% (1/7) vs. 68.6% (24/35), P = 0.012], and there were no statistically significant differences among the adjacent groups above 4a (all P > 0.05). Conclusions:TIRADS combined with BRAF V600E mutation detection can improve the sensitivity and accuracy in the diagnosis of FNAC uncertain thyroid nodules. The BRAF V600E mutation rate of TIRADS 4a and above nodules is high, so routine detection is recommended.

Diagnostic Value of American Thyroid Association Guidelines,American College of Radiology Thyroid Imaging Reporting and Data System,and Chinese Thyroid Imaging Reporting and Data System Alone and Combined With BRAFV600E Mutation in Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance / 中国医学科学院学报

Objective To explore the diagnostic efficacy of American Thyroid Association(ATA)guidelines,American College of Radiology Thyroid Imaging Report and Data System(ACR-TIRADS),and Chinese Thyroid Imaging Reporting and Data System(C-TIRADS)alone and combined with BRAFV600E mutation in atypia of undetermined significance/follicular lesion of undetermined significance(AUS/FLUS).Methods A total of 138 patients who underwent ultrasound-guided fine needle aspiration(FNA)in the Chinese PLA General Hospital from January 2020 to May 2023 were selected.The clinicopathological and ultrasound characteristics were retrospectively analyzed for each nodule.Each nodule underwent preoperative BRAFV600E mutation testing and was diagnosed according to the ATA guidelines,ACR-TIRADS,and C-TIRADS.The diagnostic efficacy of ATA guidelines,ACR-TIRADS,and C-TIRADS alone and combined with BRAFV600E mutation was assessed based on the results of histopathological diagnosis.Results The 138 AUS/FLUS thyroid nodules included 45(32.6%)benign ones and 93(67.4%)malignant ones.The patient age(t=1.444,P=0.151),gender(χ2=0.259,P=0.611),and location of nodules(χ2=2.055,P=0.358)had no statistical significance for the differentiation between benign and malignant nodules,while nodule size(Z=2.500,P=0.012),echo(χ2=14.693,P<0.001),composition(χ2=17.075,P<0.001),aspect ratio ≥1(χ2=9.477,P=0.002),and microcalcification(χ2=6.892,P=0.009)were of significance for the differentiation.When applied alone,BRAFV600E mutation showed high specificity(95.56%)and positive predictive value(95.65%).Among the three ultrasound grading systems,ACR-TIRADS had the highest sensitivity(χ2=37.923,P<0.001;χ2=40.462,P<0.001)and accuracy(χ2=81.595,P<0.001;χ2=76.912,P<0.001),while C-TIRADS had the highest specificity(χ2=11.746,P<0.001;χ2=21.235,P<0.001).However,the three systems showed no statistically significant difference in the diagnostic efficiency when applied alone(Z=1.177,P=0.239;Z=0.213,P=0.831;Z=1.016,P=0.310).The combination of BRAFV600E mutation with ACR-TIRADS or C-TIRADS improved the diagnostic efficacy of BRAFV600E mutation in distinguishing the benign and malignant AUS/FLUS nodules(Z=2.107,P=0.035;Z=2.752,P=0.006).The combination of ATA guidelines with BRAFV600E mutation increased the diagnostic accuracy of BRAFV600E mutation(χ2=20.679,P<0.001),while it had no statistically significant difference in distinguishing the benign and malignant AUS/FLUS nodules(Z=1.321,P=0.186).The combination of ATA guidelines,ACR-TIRADS,or C-TIRADS with BRAFV600E mutation improved the diagnostic efficacy of ultrasound grading systems for AUS/FLUS nodules(Z=2.770,P=0.006;Z=2.770,P=0.006;Z=2.890,P=0.004).Specifically,ACR-TIRADS combined with BRAFV600E mutation showed the highest sensitivity(χ2=4.712,P=0.030;χ2=4.712,P=0.030),while C-TIRADS combined with BRAFV600E mutation showed the highest accuracy(χ2=77.627,P<0.001;χ2=85.827,P<0.001).However,there were no statistically significant differences in diagnostic performance between the combinations(Z=1.276,P=0.202;Z=0.808,P=0.419;Z=1.615,P=0.106).Conclusion ATA guidelines,ACR-TIRADS,and C-TIRADS combined with BRAFV600E mutation can improve the diagnostic efficacy of BRAFV600E mutation or ultrasound grading system alone in AUS/FLUS nodules,which can facilitate the further management and treatment of such patients.

Application value of contrast-enhanced ultrasound combined with thyroid imaging reporting and data system classification in the differential diagnosis of benign and malignant thyroid nodules / 中国基层医药

Objective:To investigate the application value of contrast-enhanced ultrasound (CEUS) combined with thyroid imaging reporting and data system (TI-RADS) classification in the differential diagnosis of benign and malignant thyroid nodules.Methods:The clinical data of 157 thyroid nodules from 122 participants who underwent conventional ultrasound and CEUS examination from January 2016 to January 2017 in the First Hospital of Shanxi Medical University, China were collected. The image features were analyzed for conventional ultrasound and TI-RADS classification. According to CEUS results, the thyroid nodules were classified by TI-RADS. Based on pathological results, the efficacy of CEUS combined with TI-RADS classification versus conventional ultrasound combined with TI-RADS classification in the differential diagnosis of benign and malignant thyroid nodules was investigated. Results:The area under the curve of CEUS combined with TI-RADS classification (AUC = 0.900) was greater than that of conventional ultrasound combined with TI-RADS classification (AUC = 0.808). The sensitivity, specificity, accuracy, positive and negative predictive values of conventional ultrasound combined with TI-RADS classification in the differential diagnosis of benign and malignant thyroid nodules were 81.6% (80/98), 67.8% (40/59), 76.4% (120/157), 80.8% (80/99), 68.9% (40/58), respectively. They were 98.0% (96/98), 78.0% (34/59), 90.4% (142/157), 88.1% (96/109), 95.8% (46/48), respectively for CEUS combined with TI-RADS classification. The sensitivity of CEUS combined with TI-RADS classification in the differential diagnosis of benign and malignant thyroid nodules was significantly higher than that of conventional ultrasound combined with TI-RADS classification ( χ2 = 12.50, P < 0.001). Conclusion:CEUS combined with TI-RADS classification is more effective in the differential diagnosis of benign and malignant thyroid nodules than conventional ultrasound combined with TI-RADS classification.

2017 American Radiology of Society thyroid imaging report and data system classification in differentiating benign and malignant thyroid nodules / 中国介入影像与治疗学

Objective: To explore the value of thyroid imaging report and data system (TI-RADS) recommended by American Radiology of Society (ACR) in 2017 for differentiating thyroid benign and malignant nodules. Methods: Ultrasonic images of 497 thyroid nodules diagnosed with pathology were retrospectively analyzed using TI-RADS classification and given score and classification. The optimal critical score was determined with ROC curve, and the sensitivity, specificity and accuracy were calculated. The efficacy and consistency of senior and junior physicians in diagnosis of benign and malignant thyroid nodules using this optimal critical score were evaluated. Results: The area under ROC curve was 0.883 (P<0.001), and the optimal critical score was 5, while the sensitivity and specificity was 86.22% and 78.68%, respectively. The sensitivity, specificity and accuracy of senior physicians in diagnosis of benign and malignant thyroid nodules was 78.22% (176/225), 76.47% (208/272) and 77.26% (384/497), of junior physicians was 77.33% (174/225), 74.26%(202/272) and 75.65% (376/497), respectively, and moderate consistency was found between senior and junior physicians (Kappa=0.581). Conclusion: TI-RADS recommended by ACR in 2017 has high clinical value, and the optimal critical score for diagnosing benign and malignant thyroid nodule is 5.