Diagnostic value of C-TIRADS combined with BRAFV600E gene detection for different sizes of thyroid nodules in Bethesda Ⅲ

LYU Danni; JIANG Wei; CAI Yawen; ZHOU Wenwen; DENG Xuedong; LYU Jinghuan

Abstract：Objective To evaluate the diagnostic value of Chinese-TIRADS(C-TIRADS),BRAFV600E gene detection and their combination in Bethesda Ⅲ thyroid nodules of various sizes.Methods We selected 94 patients with Bethesda Ⅲ thyroid nodules who underwent fine-needle aspiration biopsy at our hospital.The nodules were categorized into two groups based on their largest diameter:≤1.0 cm(n=64)and>1.0 cm(n=30).All thyroid nodules were preoperatively evaluated using C-TIRADS crite-ria and tested for the presence of the BRAFV600E gene.The surgical pathological diagnosis was served as the reference standard.Then,we explored the diagnostic efficacy of C-TIRADS classification,BRAFV600E gene detection,and their combination for thy-roid nodules of different sizes classified as Bethesda Ⅲ.Results For both groups,the combination of C-TIRADS classification with BRAFV600E gene detection outperformed C-TIRADS alone(P<0.0001,P=0.0001).The sensitivity(98.36％,100％)and ac-curacy(96.88％,93.33％)of the combined diagnosis of the two methods were significantly improved(P<0.05).The Kappa val-ues for the combined diagnosis in both groups were 0.650 and 0.762(P<0.05),respectively,indicating higher agreement than either C-TIRADS or BRAFV600E gene detection alone.In the>1.0 cm group,the diagnostic efficacy of the BRAFV600E gene detec-tion was superior to that of C-TIRADS(P=0.0137).The mutation rates of the BRAFV600E gene in malignant nodules with a maxi-mum diameter≤0.5 cm,0.5～1.0 cm,and>1.0 cm were 50.00％,83.67％,and 87.50％,respectively.Conclusion For both groups,the combination of C-TIRADS with BRAFV600E gene detection provides superior diagnostic efficacy for Bethesda Ⅲ nod-ules,enhancing sensitivity and precision.In nodules>1.0 cm,the BRAFV600E gene detection outperforms C-TIRADS in terms of diagnostic efficacy,and the BRAFV600E mutation rate increases with the size of malignant thyroid nodules.