The Diagnostic Value Of Preoperative Serum TGAb,TPOAb Combined With BRAF Gene In Bethesda Class Ⅲ Thyroid Nodules

Objective:Evaluating the diagnostic value of preoperative serum TPOAb,TGAb combined with BRAF^V600Egene in Bethesda class III thyroid nodules,to provide a theoretical basis for clinicians to make strategic decisions,and more targeted treatment measures for patients with different statuses of TPOAb,TGAb and BRAF^V600Egene to avoid overdiagnosis and undertreatment.Methods:A retrospective analysis of the clinical data of 450 patients（preoperative fine needle aspiration of thyroid nodules are Bethesda class III）,who were admitted to the Department of Thyroid Surgery,the First Hospital of Shanxi Medical University from October 2021 to December 2022 and confirmed by surgery and pathology.According to the different preoperative statuses of TGAb,TPOAb and BRAF^V600E,patients are divided into three groups:A,B and C.The golden standards for malignant diagnosis is based on the pathological report,including thyroid carcinoma（papillary thyroid carcinoma,follicular thyroid carcinoma,Hurthle cell carcinoma,poorly differentiated thyroid carcinoma,undifferentiated thyroid carcinoma,and medullary thyroid cancer）.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Youden index of BRAF^V600E,TPOAb,TGAb,and BRAF^V600Ecombined with TPOAb and TGAb in the diagnosis of thyroid cancer have been analyzed respectively to evaluate the pros and cons of different diagnostic methods.Results:In group A,the differences in parallel diagnostic sensitivity of thyroid malignant carcinoma of BRAF^V600Eand TPOAb are statistically significant（P=0.00,0.00,P<0.05）,compared with BRAF^V600Eand TPOAb respectively but in specificity are not statistically significant（P=0.08,0.65,P>0.05）.The differences in parallel diagnostic accuracy of thyroid malignant carcinoma of BRAF^V600Eand TPOAb are statistically significant differences（P=0.04,0.00,P<0.05）,compared with BRAF^V600Eand TPOAb respectively.The differences in tandem diagnostic sensitivity of thyroid malignant carcinoma of BRAF^V600Eand TPOAb are statistically significant（P=0.00,0.01,P<0.05）,compared with BRAF^V600Eand TPOAb respectively.The difference in tandem diagnostic specificity of thyroid malignant carcinoma of BRAF^V600Eand TPOAb is not statistically significant（P=0.44,P>0.05）,compared with BRAF^V600Ealone but is statistically significant（P=0.04,P<0.05）,compared with TPOAb alone.The difference in accuracy is statistically significant（P=0.00,P<0.05）,compared with BRAF^V600Ealone.But there is no statistically significant difference in the accuracy（P=0.21,P>0.05）,compared with TPOAb.In group B,the differences in parallel diagnostic sensitivity of thyroid malignant carcinoma of BRAF^V600Eand TGAb are statistically significant（P=0.00,0.00,P<0.05）,compared with BRAF^V600Eand TGAb respectively but in specificity are not statistically significant（P=0.05,0.66,P≥0.05）.The differences in parallel diagnostic accuracy of thyroid malignant carcinoma of BRAF^V600Eand TGAb is no statistically significant（P=0.24,P>0.05）,compared with BRAF^V600Ealone.The difference in accuracy is statistically significant（P=0.00,P<0.05）,compared with TGAb alone.The difference in tandem diagnostic sensitivity of thyroid malignant carcinoma of BRAF^V600Eand TGAb is statistically significant（P=0.00,P<0.05）,compared with BRAF^V600Ebut in specificity is not statistically significant（P=0.44,P>0.05）.The difference in tandem diagnostic sensitivity of thyroid malignant carcinoma of BRAF^V600Eand TGAb is not statistically significant（P=0.06,P>0.05）,compared with TGAb but in specificity is statistically significant（P=0.02,P<0.05）.The difference in tandem diagnostic accuracy of thyroid malignant carcinoma of BRAF^V600Eand TGAb is statistically significant（P=0.00,P<0.05）,compared with BRAF^V600Ealone.But there is no statistically significant difference in the accuracy（P=0.48,P>0.05）,compared with TGAb.In group C,the differences in parallel diagnostic sensitivity of thyroid malignant carcinoma of BRAF^V600Eand TPOAb,TGAb are statistically significant（P=0.00,0.00,P<0.05）,compared with BRAF^V600Eand TPOAb,TGAb respectively but in specificity are not statistically significant（P=0.49,0.49,P>0.05）.The differences in parallel diagnostic accuracy of thyroid malignant carcinoma of BRAF^V600Eand TPOAb,TGAb are statistically significant（P=0.00,0.00,P<0.05）,compared with BRAF^V600Eand TPOAb,TGAb respectively.The differences in tandem diagnostic sensitivity of thyroid malignant carcinoma of BRAF^V600Eand TPOAb,TGAb are statistically significant（P=0.00,0.00,P<0.05）,compared with BRAF^V600Eand TPOAb,TGAb respectively but in specificity are not statistically significant（P=0.24,0.24,P>0.05）.Moreover,the differences in tandem diagnostic accuracy of thyroid malignant carcinoma of BRAF^V600Eand TPOAb,TGAb are statistically significant（P=0.00,0.00,P<0.05）,compared with BRAF^V600Eand TPOAb,TGAb respectively.Conclusion:For patients of thyroid nodules whose results of FNAC are Bethesda III,with the parallel diagnosis,TPOAb and TGAb can make up for the shortcomings of BRAF^V600E,which improves the diagnostic sensitivity,negative prediction value and accuracy of hyroid malignant tumor.With tandem diagnosis,TPOAb and TGAb can significantly improve the diagnostic specificity and positive predictive value??of thyroid malignant tumor,but the accuracy rate decreases significantly.