[Diagnostic Value of American Thyroid Association Guidelines,American College of Radiology Thyroid Imaging Reporting and Data System,and Chinese Thyroid Imaging Reporting and Data System Alone and Combined With BRAF Mutation in Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance].

Objective To explore the diagnostic efficacy of American Thyroid Association(ATA)guidelines,American College of Radiology Thyroid Imaging Report and Data System(ACR-TIRADS),and Chinese Thyroid Imaging Reporting and Data System(C-TIRADS)alone and combined with BRAF mutation in atypia of undetermined significance/follicular lesion of undetermined significance(AUS/FLUS).Methods A total of 138 patients who underwent ultrasound-guided fine needle aspiration(FNA)in the Chinese PLA General Hospital from January 2020 to May 2023 were selected.The clinicopathological and ultrasound characteristics were retrospectively analyzed for each nodule.Each nodule underwent preoperative BRAF mutation testing and was diagnosed according to the ATA guidelines,ACR-TIRADS,and C-TIRADS.The diagnostic efficacy of ATA guidelines,ACR-TIRADS,and C-TIRADS alone and combined with BRAF mutation was assessed based on the results of histopathological diagnosis.Results The 138 AUS/FLUS thyroid nodules included 45(32.6%)benign ones and 93(67.4%)malignant ones.The patient age(=1.444,=0.151),gender(=0.259,=0.611),and location of nodules(=2.055,=0.358)had no statistical significance for the differentiation between benign and malignant nodules,while nodule size(=2.500,=0.012),echo(=14.693,<0.001),composition(=17.075,<0.001),aspect ratio ≥1(=9.477,=0.002),and microcalcification(=6.892,=0.009)were of significance for the differentiation.When applied alone,BRAF mutation showed high specificity(95.56%)and positive predictive value(95.65%).Among the three ultrasound grading systems,ACR-TIRADS had the highest sensitivity(=37.923,<0.001;=40.462,<0.001)and accuracy(=81.595,<0.001;=76.912,<0.001),while C-TIRADS had the highest specificity(=11.746,<0.001;=21.235,<0.001).However,the three systems showed no statistically significant difference in the diagnostic efficiency when applied alone(=1.177,=0.239;=0.213,=0.831;=1.016,=0.310).The combination of BRAF mutation with ACR-TIRADS or C-TIRADS improved the diagnostic efficacy of BRAF mutation in distinguishing the benign and malignant AUS/FLUS nodules(=2.107,=0.035;=2.752,=0.006).The combination of ATA guidelines with BRAF mutation increased the diagnostic accuracy of BRAF mutation(=20.679,<0.001),while it had no statistically significant difference in distinguishing the benign and malignant AUS/FLUS nodules(=1.321,=0.186).The combination of ATA guidelines,ACR-TIRADS,or C-TIRADS with BRAF mutation improved the diagnostic efficacy of ultrasound grading systems for AUS/FLUS nodules(=2.770,=0.006;=2.770,=0.006;=2.890,=0.004).Specifically,ACR-TIRADS combined with BRAF mutation showed the highest sensitivity(=4.712,=0.030;=4.712,=0.030),while C-TIRADS combined with BRAF mutation showed the highest accuracy(=77.627,<0.001;=85.827,<0.001).However,there were no statistically significant differences in diagnostic performance between the combinations(=1.276,=0.202;=0.808,=0.419;=1.615,=0.106).Conclusion ATA guidelines,ACR-TIRADS,and C-TIRADS combined with BRAF mutation can improve the diagnostic efficacy of BRAF mutation or ultrasound grading system alone in AUS/FLUS nodules,which can facilitate the further management and treatment of such patients.