| Background: Thyroid nodules are very common in the population.Thyroid cancer is the most common endocrine malignant tumor in the human body,accounting for about2.1% of all cancers in the world,77% of which occur in women.Timely diagnosis and treatment of thyroid cancer is very important for patients to achieve long-term survival.Thyroid examination methods include ultrasound,CT,MRI,ECT.CT,MRI and ECT are not suitable for routine examination because they are expensive or have side effects on human body.Therefore,it is necessary to evaluate routine ultrasound,ultrasound-guided fine needle aspiration cytology and Braf gene detection as preoperative diagnostic methods for patients with thyroid nodules.Objective: By comparing with pathological results,the diagnostic value of TI-RADS,Bethesda system and BRAF gene mutation in benign and malignant thyroid nodules was compared,and the diagnostic performance of combined diagnosis of the three methods was evaluated,so as to further explore the best way of preoperative diagnosis of thyroid nodules,In order to provide new ideas for the clinical personalized management of patients with thyroid nodules.Materials and Methods: According to the inclusion and exclusion criteria,792 patients with 878 thyroid nodules were included in this study.All patients underwent thyroid routine ultrasound,ultrasound-guided fine needle aspiration cytology and BRAF gene detection.The size,location,boundary,calcification,aspect ratio and adjacent lymph nodes of thyroid nodules were collected,and then the thyroid nodules were classified by Kwak-RADS.After the improvement of routine ultrasound examination,ultrasound-guided fine needle aspiration of thyroid nodules was performed.Cytological examination was performed by puncture cytology and BRAF gene detection.Thyroid cytological classification Bethesda systerm system was used to grade the samples.Pathological results were taken as the gold standard to compare the value of the three methods in the differential diagnosis of thyroid nodules.According to the final diagnosis,the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)and accuracy of ti-rads,Bethesda system and BRAF gene detection were calculated respectively.The ROC curves of the three diagnostic methods were drawn.The area under the curve was compared to evaluate the accuracy of each examination method in the diagnosis of thyroid nodules.The ROC of the combined diagnosis of the three examination methods was obtained by logistic regression model The area under the curve was used to evaluate the joint diagnostic performance.Result: Among 878 nodules,373 were benign and 505 were malignant.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of three diagnostic methods: TI-RADS: 72.1%,96.2%,98.6%,48.2%;Bethesda System:98.2%,87.9%,97.8%,93.4%;BRAF gene mutation: 91.1%,89.3%,92.0%,89.0%.The accuracy and area under curve of TI-RADS were 77.2% and 0.74(95% CI: 0.70 – 0.77);the accuracy and area under curve of Bethesda system were 93.4% and 0.94(95% CI:0.92-0.95);the accuracy and area under curve of BRAF gene mutation were 90.8% and0.91(95% CI: 0.89-0.92),The area under the ROC curve(AUC)of combined diagnosis of the three was 0.99(95% CI 0.984-0.995),which significantly improved the prediction ability of thyroid malignant nodulesmalignant nodules.Conclusion: TI-RADS,Bethesda system and BRAF gene detection have certain diagnostic value in differentiating benign and malignant thyroid nodules.The sensitivity and negative predictive value of Bethesda system are the highest,and the area under the curve is also higher than other systems.Bethesda system may be the most effective method for preoperative diagnosis of thyroid nodules.The other three combined diagnosis may help to improve the accuracy of thyroid cancer diagnosis. |
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