Abstract
The thyroid imaging reporting and data system (TIRADS) and Bethesda system for reporting thyroid cytopathology (BSRTC) have been used for interpretation of ultrasound and fine-needle aspiration cytology (FNAC) results of thyroid nodules. BRAFV600E mutation analysis is a molecular tool in diagnosing thyroid carcinoma. Our objective was to compare the diagnostic value of these methods in differentiating high-risk thyroid nodules. Total 220 patients with high-risk thyroid nodules were recruited in this prospective study. They all underwent ultrasound, FNAC and BRAFV600E mutation analysis. The sensitivity and specificity of TIRADS were 73.1% and 88.4%. BSRTC had higher specificity (97.7%) and similar sensitivity (77.6%) compared with TIRADS. The sensitivity and specificity of BRAFV600E mutation (85.1%, 100%) were the highest. The combination of BSRTC and BRAFV600E mutation analysis significantly increased the efficiency, with 97.8% sensitivity, 97.7% specificity. In patients with BSRTC I-III, the mutation rate of BRAFV600E was 64.5% in nodules with TIRADS 4B compared with 8.4% in nodules with TIRADS 3 or 4A (P < 0.001). Our study indicated that combination of BSRTC and BRAFV600E mutation analysis bears a great value in differentiating high-risk thyroid nodules. The TIRADS is useful in selecting high-risk patients for FNAB and patients with BSRTC I-III for BRAFV600E mutation analysis.
Highlights
Studies with 7,753 thyroid nodules and showed that thyroid imaging reporting and data system (TIRADS) had a pooled sensitivity and specificity of 0.75 and 0.69, respectively
We evaluated the diagnostic value of TIRADS, Bethesda system for reporting thyroid cytopathology (BSRTC) and BRAFV600E mutation analysis in differentiating high-risk thyroid nodules and explored the utilization of these methods for better diagnostic performance
We evaluated the efficiency of TIRADS, BSRTC and BRAFV600E mutation analysis in differentiating high-risk thyroid nodules in clinical practice
Summary
Studies with 7,753 thyroid nodules and showed that TIRADS had a pooled sensitivity and specificity of 0.75 and 0.69, respectively. US-guided fine-needle aspiration biopsy (FNAB) is currently the essential triage approach for the preoperative evaluation of high-risk thyroid nodules. The Bethesda system for reporting thyroid cytopathology (BSRTC) was developed by American National Cancer Institute in 2009 to standardize the interpretation of the fine-needle aspiration cytology (FNAC) results[7]. Studies have shown that BRAFV600E mutation is only present in papillary thyroid carcinoma (PTC) and PTC-derived anaplastic thyroid cancer. It has been demonstrated that the combination of BRAFV600E mutation analysis and cytology results can improve diagnostic performances of FNAB13,14. We evaluated the diagnostic value of TIRADS, BSRTC and BRAFV600E mutation analysis in differentiating high-risk thyroid nodules and explored the utilization of these methods for better diagnostic performance
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