Abstract:

Objective To evaluate the diagnostic value of ultrasound-guided fine needle aspiration cytology (UG-FNAC) combined with BRAF^V600E gene detection for American College of Radiology-thyroid imaging reporting and data system (ACR-TIRADS) category 4 thyroid nodules(TN). Methods A retrospective analysis involved 471 patients evaluating TN of ACR-TIRADS 4 by ultrasound examination, who admitted to Northern Jiangsu People's Hospital Affiliated to Yangzhou University from January 2018 to June 2021, and the patients underwent preoperative UG-FNAC and BRAF^V600E gene detection. Thin-layer (liquid-based) cervical cytology and fluorescence quantitative PCR were used for detecting puncture specimens and BRAF^V600E mutation, respectively. Using postoperative pathology as the gold standard, the receiver operating characteristic (ROC) curve of TN (ACR-TIRADS 4) was constructed by UG-FNAC and BRAF^V600E detection and the combined diagnosis of the two, and the diagnostic efficacy was evaluated. Results The sensitivity(Se) and specificity(Sp) of TN (TIRADS 4) using UG-FNAC or BRAF^V600E gene detection were 75.8%, 98.8% and 56.7%, 98.8%, respectively. Se and Sp using the combination of both were 95.6% and 98.3%, respectively; areas under curve (AUC) using the combination (0.970) was higher than UG-FNAC (0.873), or BRAF^V600E detection alone (0.778)(P<0.05); AUC of TN (TIRADS 4a, 4b, and 4c ) using the combination were 0.961, 0.972, and 0.981, respectively. Conclusion UG-FNAC combined with BRAF^V600E gene detection can effectively improve the accuracy of preoperative diagnosis of TN (ACR-TIRADS 4).

Key words: thyroid nodule, endoscopic ultrasound-guided fine aspiration, cytological techniques, proto-oncogene proteins B-raf