The Value Of BRAFV600E Mutation Analysis Combined With Ultasound Riask Stratification In Bethesda Category ? Thyroid Nodules

Objective: The purpose of the study was to evaluate the application value of the BRAFV600 E mutation analysis,ultrasound pattern-based risk stratification,and the two combinative modality in the diagnosis of Bethesda category ? thyroid nodule.Methods: From December 2016 to July 2018,81 thyroid nodules which underwent fine-needle aspiration biopsy(FNAB)examination and were diagnosed with Bethesda category ?,and then BRAFV600 E mutation analysis were performed with the FNAB samples were enrolled in the study.The ultrasound feature and ultrasound risk stratification of the 81 Bethesda category ? thyroid nodules were analyzed according to the ultrasound pattern-based risk stratification standard recommended by American Thyroid Association(ATA)Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer(hereinafter referred to as "ATA guidelines").Surgical pathology as the "gold standard",the diagnostic performances of theBRAFV600 E mutation analysis,ultrasound pattern-based risk stratification based on ATA guidelines,and the two combinative modality in the diagnosis of Bethesda category ? thyroid nodule were evaluated by the receiver operating characteristic(ROC)curve.And compare the application value of the three different diagnostic models in the Bethesda category ? thyroid nodules.Results: There were 25(30.9%,25/81)benign and 56(69.1%,56/81)malignant nodules of the 81 Bethesda category ? nodules.Positive BRAFV600 E mutation,the size of thyroid nodules and irregular margin,microcalcifications,and taller-than-wide of the suspicious US features were significantly associated with malignancy in thyroid nodules(all P < 0.05),however,the gender and age of the patients did not show a significant difference between malignant and benign thyroid nodules.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and area under the receiver operating characteristic curve(AUROC)of Bethesda category ? thyroid nodule diagnosed by three different diagnostic modes were as follows:(1)BRAFV600E mutation analysis: 71.4%,96.0%,97.6%,60.0%,79.0% and0.837;(2)ultrasound risk stratification based on ATA guidelines: 75.0%,84.0%,91.3%,60.0%,77.8% and 0.795;(3)BRAFV600E mutation analysis combined with ultrasound risk stratification based on ATA guidelines: 94.6%,84.0%,93.0%,87.5%,91.4% and 0.893.Comparison of the diagnostic value of three different diagnostic modes for Bethesda category ? thyroid nodules found that:(1)BRAFV600E mutation analysis and ultrasound risk stratification based on ATA guidelines had no statistical difference in the differential diagnosis between benign and malignant of Bethesda category ? thyroid nodules(AUROC: 0.837 vs 0.795,P > 0.05);(2)compared with BRAFV600 E mutation analysis,the diagnosis mode of BRAFV600 E mutation analysis combined with ultrasoundrisk stratification based on ATA guidelines could slightly improve the diagnostic efficiency(AUROC: 0.893 vs 0.837,P=0.28),significantly improve the diagnostic sensitivity(94.6% vs 74.1%,P < 0.001).(3)compared with ultrasound risk stratification based on ATA guidelines,the diagnosis mode of BRAFV600 E mutation analysis combined with ultrasound risk stratification based on ATA guidelines significantly improved the diagnostic efficacy of Bethesda category ? thyroid nodules(AUROC: 0.893 vs 0.795,P < 0.001).Conclusions:(1)Ultrasound risk stratification based on ATA guidelines has good sensitivity,specificity and accuracy in the differential diagnosis of benign and malignant thyroid nodules of Bethesda category ?,which is conducive to the accurate clinical diagnosis and management of these thyroid nodules;(2)BRAFV600E mutation analysis has high specificity and moderate sensitivity for the diagnosis of Bethesda category ? thyroid nodules,which is helpful for the clinical detection of thyroid cancer that has been missed by cytology;(3)The diagnostic model of BRAFV600 E mutation analysis of thyroid nodules FNAB specimen combined with the ultrasound pattern-based risk stratification based on ATA guidelines can effectively improve the diagnostic efficiency of Bethesda category ? thyroid nodules,which is helpful to further improve the application value of ultrasound in the diagnosis of thyroid nodule.