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Title: [Diagnostic values of BRAF(V600E) mutation analysis and Bethesda system for reporting thyroid cytopathology in thyroid nodules with TIRADS 4 and 5].
Author: Han Y, Zhao BW, Li SY, Lyu JG, Shou JD, Xu HS, Lou HY, Xu LL, Gao L, Xu SX, Zhu J.
Journal: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi; 2017 Sep 07; 52(9):686-691. PubMed ID: 28910894.
Abstract:
Objective: To evaluate the diagnostic efficacies of BRAF(V600E) testing and Bethesda system for reporting thyroid cytopathology (BSRTC) in thyroid nodules with thyroid imaging reporting and data system (TIRADS) category 4 and 5. Methods: A total of 187 thyroid nodules in 187 patients underwent the examinations of ultrasound-guided fine needle aspiration cytology (FNAC) and BRAF(V600E) mutation were analyzed retrospectively. Receive operating characteristic (ROC) curve was used to investigate the diagnostic values of both methods and the clinical application of BRAF(V600E) combined with BSRTC was evaluated. SPSS17.0 software was used to analyze the data. Results: Among 187 thyroid nodules, 123 were malignant nodules confirmed with histopathological examination and 64 benign nodules determined by FNAC, histopathological examination, or long-term follow-up. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BRAF(V600E) test were better than those of BSRTC [69.1%, 98.4%, 98.8%, 62.4%(χ(2)=77.3, P=0.000) vs 62.6%, 93.8%, 95.1%, 56.6%(χ(2)=54.4, P=0.000)]. While the sensitivity, specificity, PPV and NPV of the combined test of BRAF(V600E) and BSRTC for diagnosis of malignant thyroid nodules were 87.8%, 92.2%, 95.6%, 79.7%(χ(2)=112.6, P=0.000), respectively. The area under the ROC curve for the combined test was higher than that for each of tests (0.900 vs 0.858 or 0.838). Conclusions: The combined test of BRAF(V600E) mutation and BSRTC has a higher diagnostic efficacy for malignant thyroid nodules compared with BRAF(V600E) mutation or BSRTC alone. 目的： 比较BRAF(V600E)检测和Bethesda甲状腺细胞病理报告系统(BSRTC)在TIRADS 4～5类甲状腺结节良恶性诊断中的应用价值，探索两种方法联合应用的诊断意义。 方法： 回顾性分析浙江大学医学院附属邵逸夫医院行超声诊断诊为TIRADS 4～5类的甲状腺结节共187个(187例患者)，均予超声引导下细针穿刺细胞学检查(FNAC)及BRAF(V600E)检测，构建受试者工作特征曲线(ROC)来评估各方法的诊断价值，探讨其联合应用的意义。采用SPSS 17.0软件对数据进行统计学分析。 结果： 123个结节为恶性，均经手术病理结果证实，64个结节为良性，经细胞学结果或手术病理结果证实，或经长期随访诊为良性。BSRTC诊断恶性结节的灵敏性、特异性、阳性预测值、阴性预测值分别是62.6%、93.8%、95.1%、56.6%(χ(2)＝54.4, P＝0.000)；BRAF(V600E)检测诊断恶性结节的灵敏性、特异性、阳性预测值、阴性预测值分别是69.1%、98.4%、98.8%、62.4%(χ(2)＝77.3, P＝0.000)；联合应用后诊断的灵敏性、特异性、阳性预测值、阴性预测值分别是87.8%、92.2%、95.6%、79.7%(χ(2)＝112.6, P＝0.000)，其ROC曲线下面积(AUC)高于其他两种方法(0.900比0.858、0.838)。 结论： BRAF(V600E)检测、BSRTC对TIRADS 4～5类甲状腺结节良恶性的诊断具有重要价值，两者联合对恶性结节的检出价值更高。.

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