Li Qiang, Yang Lu, Lv Jianghong, Xu Lilong, Zhang Murui, Li Shiyan
Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China.
Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China.
Endocrine. 2022 Dec;78(3):507-516. doi: 10.1007/s12020-022-03176-8. Epub 2022 Sep 24.
To explore the utility of the BRAF mutation in combination with the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) in the management of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) thyroid nodule (TN).
138 AUS/FLUS TNs in 129 patients were included. Each TN underwent preoperative BRAF mutation analysis and was classified using the C-TIRADS. Histopathologic diagnosis served as reference standard.
46 benign TNs and 92 malignant TNs were identified. The C-TIRADS 4C and 5 (OR = 10.409, P = 0.000), BRAF mutation (OR = 36.493, P = 0.000) were independent predictors of malignant nodules. There were significant differences in malignancy rate among the different C-TIRADS TNs (P = 0.000), and these TNs with higher C-TIRADS were associated with increased malignancy rate (P for trend = 0.000). The rate of the nodule with BRAF mutation increased with the increase of C-TIRADS (P for trend = 0.001). For AUS/FLUS TNs without BRAF mutation, the malignancy rates of the C-TIRADS 3, 4A, 4B, 4C, and 5 were 0%, 21.4%, 20.8%, 70.8%, and 100%, respectively (P = 0.000), and the malignancy rate increased from C-TIRADS 3 to C-TIRADS 5 (P for trend = 0.000). C-TIRADS and BRAF mutation had similar diagnostic efficacy (P > 0.05), and the sensitivity, negative predictive value, and accuracy of the combination were significantly higher than BRAF gene or C-TIRADS alone (P < 0.05).
C-TIRADS can effectively provide risk stratification for AUS/FLUS nodules. The combination is helpful in selecting appropriate management for AUS/FLUS patients.
探讨BRAF突变联合中国甲状腺影像报告和数据系统（C-TIRADS）在意义不明确的非典型性/意义不明确的滤泡性病变（AUS/FLUS）甲状腺结节（TN）管理中的应用价值。
纳入129例患者的138个AUS/FLUS TN。每个TN均进行术前BRAF突变分析，并使用C-TIRADS进行分类。组织病理学诊断作为参考标准。
共识别出46个良性TN和92个恶性TN。C-TIRADS 4C和5类（OR = 10.409，P = 0.000）、BRAF突变（OR = 36.493，P = 0.000）是恶性结节的独立预测因素。不同C-TIRADS分类的TN的恶性率存在显著差异（P = 0.000），且C-TIRADS分类越高，恶性率越高（趋势P = 0.000）。BRAF突变结节的比例随C-TIRADS升高而增加（趋势P = 0.001）。对于无BRAF突变的AUS/FLUS TN，C-TIRADS 3、4A、4B、4C和5类的恶性率分别为0%、21.4%、20.8%、70.8%和100%（P = 0.000），且恶性率从C-TIRADS 3类到C-TIRADS 5类逐渐升高（趋势P = 0.000）。C-TIRADS和BRAF突变具有相似的诊断效能（P > 0.05），两者联合的敏感度、阴性预测值和准确性均显著高于单独的BRAF基因或C-TIRADS（P < 0.05）。
C-TIRADS能有效为AUS/FLUS结节提供风险分层。联合应用有助于为AUS/FLUS患者选择合适的管理方案。
