<i>BRAF</i>^V600E <i>vs</i>. TIRADS in predicting papillary thyroid cancers in Bethesda system I, III, and V nodules

Abstract

<h3>Objective</h3> Bethesda System for Reporting Thyroid Cytopathology (BSRTC) categories I, III, and V account for a significant proportion of fine needle aspiration cytology (FNAC) diagnoses. This study aimed to compare the diagnostic efficacy of <i>BRAF</i>^V600E mutation and the Thyroid Imaging Reporting and Data System (TIRADS) classification in differentiating papillary thyroid cancers (PTCs) from benign lesions among BSRTC I, III, and V nodules. <h3>Methods</h3> A total of 472 patients with 479 nodules were enrolled in this prospective study. Ultrasound, <i>BRAF</i>^V600E mutation testing, and FNAC were performed in each nodule, followed by surgery or regular ultrasound examination. <h3>Results</h3> In the BSRTC I category, <i>BRAF</i>^V600E showed similar sensitivity, higher specificity, and lower accuracy when compared with TIRADS. In the BSRTC III/V category, the sensitivity, specificity, and accuracy of <i>BRAF</i>^V600E were similar to those of TIRADS. In comparison to <i>BRAF</i>^V600E alone, the combination of the two methods significantly improved sensitivity (BSRTC I: 93.6% <i>vs.</i> 67.7%, <i>P</i> &lt; 0.01; BSRTC III: 93.8% <i>vs.</i> 75.0%, <i>P</i> &lt; 0.01; BSRTC V: 96.0% <i>vs.</i> 85.3%, <i>P</i> &lt; 0.001). When compared with TIRADS alone, the combination improved sensitivity in BSRTC I nodules (93.6% <i>vs.</i> 74.2%, <i>P</i> &lt; 0.05), increased sensitivity and decreased accuracy in BSRTC III nodules (93.8% <i>vs.</i> 75.0%, <i>P</i> &lt; 0.01, 91.0% <i>vs.</i> 93.6%, <i>P</i> &lt; 0.01), and improved both sensitivity and accuracy in BSRTC V nodules (96.0% <i>vs.</i> 82.0%, <i>P</i> &lt; 0.001; 94.2% <i>vs.</i> 81.3%, <i>P</i> &lt; 0.001). <h3>Conclusions</h3> <i>BRAF</i>^V600E exhibited higher specificity and lower accuracy compared with TIRADS in BSRTC I nodules, while the two methods showed similar diagnostic value in BSRTC III/V nodules. The combination of the two methods distinctly improved sensitivity in the diagnosis of PTCs in BSRTC I, III, and V nodules.