Department of Pathology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
Medical School of Chinese PLA, Beijing, China.
Endocrine. 2024 May;84(2):549-559. doi: 10.1007/s12020-023-03586-2. Epub 2023 Nov 9.
To investigate the value of Korean, American, and Chinese ultrasound risk stratification systems combined with BRAF(V600E) mutation in the detection of papillary thyroid carcinoma (PTC)within cytologically indeterminate thyroid nodules (CITNs).
A single-center retrospective study encompassed 511 CITNs selected from 509 patients between January 2020 and July 2023.Each nodule underwent surgical treatment and was classified according to three distinct systems. Receiver operating characteristic (ROC) curves were plotted using histopathological diagnosis as the reference standard, and diagnostic performance was compared.
The three ultrasound stratification systems showed an elevated malignant risk with increasing grades (all P for trend < 0.001). The cut-off values for Korean, American, and Chinese systems were 5, 5, and 4c, and their respective area under the curves (AUCs) were 0.735, 0.778, and 0.783.The combination of BRAF (V600E) mutation significantly enhanced the diagnostic efficacy for the Korean(0.773vs0.735, P < 0.001), American (0.809vs0.778, P < 0.001) and Chinese (0.815vs0.783, P < 0.001) stratification systems in distinguishing CITNs without compromising specificity. When the three stratification systems were applied individually or combined with BRAF (V600E) mutation, the AUCs of the American and Chinese systems were similar (all P > 0.05), both of which were higher than the AUC of the Korean system (all P < 0.05). The American system exhibited higher specificity compared to the Chinese and Korean systems (all P < 0.001), whereas the Chinese system demonstrated higher sensitivity and accuracy when compared to the American and Korean systems (all P < 0.001).
Korean, American and Chinese stratification systems present potential in the differential diagnosis of CITNs. BRAF (V600E) mutation can significantly improve the detection rate of malignant nodules within CTNs, particularly PTC. Notably, the American and Chinese systems demonstrate superior overall diagnostic performance among these systems.
探讨韩国、美国和中国的超声风险分层系统联合 BRAF(V600E) 突变在细胞学不确定的甲状腺结节（CITN）中检测甲状腺乳头状癌（PTC）的价值。
本单中心回顾性研究纳入了 2020 年 1 月至 2023 年 7 月期间 509 例患者中的 511 个 CITN。每个结节均接受了手术治疗，并根据三种不同的系统进行分类。以组织病理学诊断为参考标准绘制受试者工作特征（ROC）曲线，并比较诊断性能。
三种超声分层系统的恶性风险随分级的升高而升高（所有趋势 P<0.001）。韩国、美国和中国系统的截断值分别为 5、5 和 4c，其曲线下面积（AUC）分别为 0.735、0.778 和 0.783。BRAF(V600E)突变的联合显著提高了韩国（0.773 比 0.735，P<0.001）、美国（0.809 比 0.778，P<0.001）和中国（0.815 比 0.783，P<0.001）分层系统对无假阳性 CITN 的诊断效能。当单独应用三种分层系统或联合 BRAF(V600E) 突变时，美国和中国系统的 AUC 相似（均 P>0.05），均高于韩国系统的 AUC（均 P<0.05）。美国系统的特异性高于中国和韩国系统（均 P<0.001），而中国系统的敏感性和准确性高于美国和韩国系统（均 P<0.001）。
韩国、美国和中国的分层系统在 CITN 的鉴别诊断中具有潜在价值。BRAF(V600E) 突变可显著提高 CITN 中恶性结节的检出率，特别是 PTC。值得注意的是，美国和中国系统在这些系统中表现出更好的整体诊断性能。
