Comparison of diagnostic value of TIRADS, BSRTC, BRAFV600E mutation detection and their combined use in differentiating thyroid nodules

Objective To compare the diagnostic efficiency of the thyroid imaging reporting and data system(TIRADS), the Bethesda system for reporting thyroid cytopathology(BSRTC) and BRAFV600E detection, and their combined use in the differentiation between benign and malignant thyroid nodules. Methods One hundred and twenty eight patients with 128 thyroid nodules who were scheduled for ultrasound-guided fine-needle aspiration biopsy(FNAB) were recruited for the study. All of them underwent ultrasound, fine-needle aspiration cytology(FNAC) examination, and BRAFV600E detection. TIRADS and BSRTC systems were adopted to judge the ultrasound and FNAC results. The receiver operating characteristic curve was established to assess the diagnostic value of each method. Results The sensitivity, specificity, and AUC of TIRADS were 74.3%, 84.5%, and 0.794, respectively. BSRTC had higher specificity(98.3%) and equal sensitivity compared to TIRADS. The sensitivity, specificity, and AUC of BRAFV600E detection were the highest ones among the three methods. Combinations of different methods could increase the diagnostic sensitivity and accuracy. The combination of FNAC and BRAFV600E detection significantly increased the diagnostic efficiency(AUC=0.984), with sensitivity 98.6% and specificity 98.3%. Conclusions The diagnostic value of BRAFV600E detection in the differentiation of benign and malignant thyroid nodules is better than both TIRADS and BSRTC, and the combination of FNAC and BRAFV600E detection reaches the best diagnostic efficiency. (Chin J Endocrinol Metab, 2016, 32: 380-385) Key words: Thyroid nodules; Fine-needle aspiration; Thyroid imaging reporting and data system; Bethesda system for reporting thyroid cytopathology; BRAFV600E mutation