【摘要】 目的 探讨2020年中国超声甲状腺影像报告和数据系统（C-TIRADS）联合BRAF^V600E基因检测在甲状腺细胞病理学Bethesda报告系统（BSRTC）Ⅲ类结节良恶性鉴别诊断中的价值。方法 回顾性分析2020年10月～2022年10月于我院行超声引导甲状腺细针穿刺活检细胞学结果为BSRTCⅢ类的124例患者共156个结节，所有结节均行C-TIRADS分类及BRAF^V600E基因检测，并均经手术病理证实。以手术病理结果为金标准，比较C-TIRADS、BRAF^V600E检测及二者联合在BSRTCⅢ类甲状腺结节中的诊断效能。结果 156个BSRTCⅢ类甲状腺结节最终术后病理结果显示良性结节93个，恶性结节63个；BRAF^V600E基因突变阳性48个，阴性108个。C-TIRADS分类ROC曲线下面积为0.834（95%CI:0.765～0.902）;C-TIRADS分类和BRAF^V600E基因检测鉴别诊断BSRTCⅢ类甲状腺结节良恶性的敏感度分别为73.0%、76.2%，特异性分别为88.2%、98.9%，阳性预测值分别为80.7%、97.9%，阴性预测值分别为82.8%、85.2%，准确度分别为82.1%、89.1%。二者联合诊断的敏感度、特异性、阳性预测值、阴性预测值、准确度分别为90.4%、96.8%、95.0%、93.8%、94.2%。与C-TIRADS、BRAF^V600E基因检测单独诊断相比，联合诊断具有较高的敏感度（χ²=6.435,P=0.011；χ²=4.629,P=0.032）和阴性预测值（χ²=5.588,P=0.018；χ²=3.875,P=0.049）。结论 C-TIRADS超声分类和BRAF^V600E基因检测对BSRTCⅢ类甲状腺结节均有较高的诊断效能，两者联合运用可提高诊断的敏感度及阴性预测值，有助于BSRTCⅢ类甲状腺结节的鉴别诊断。更多还原

【Abstract】 Objective To investigate the value of 2020 Chinese Thyroid Imaging Report and Data System（C-TIRADS） combined with BRAF^V600Etesting in the differential diagnosis of benign and malignant category III nodules in Bethesda system for reporting thyroid cytopathology（BSRTC）. Methods A total of 156 thyroid nodules in 124 patients with BSRTC category Ⅲwho underwent ultrasound-guided fine needle aspiration biopsy at the Second Affiliated Hospital of Fujian Medical University from October 2020 to October 2022 were selected. Each nodule underwent C-TIRADS classification and BRAF^V600E testing and was confirmed by histopathology. The diagnostic efficacy of C-TIRADS, BRAF^V600Etesting, and their combination in BSRTC category Ⅲ nodules were assessed according to histopathology findings. Results According to histopathology findings, 93 benign nodules and 63 malignant nodules in 156 nodules, 48 positive and 108 negative for BRAF^V600Etesting. The area under the ROC curve of C-TIRADS classification was 0.834（95% CI: 0.765-0.902）. The sensitivities of C-TIRADS classification and BRAF^V600Etesting were 73.0% and 76.2%, the specificity were 88.2% and 98.9%, the positive predictive value were 80.7% and 97.9%, the negative predictive value were 82.8% and 85.2%, the accuracy were 82.1% and 89.1%,respectively.The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the two combined diagnosis were 90.4%, 96.8%, 95.0%, 93.8% and 94.2%, respectively. The combination of two methods significantly increased the sensitivity（χ²=6.435, P=0.011; χ²=4.629, P=0.032） and negative predictive value（χ²=5.588, P=0.018; χ²=3.875, P=0.049） when compared with C-TIRADS and BRAF^V600Etesting in BSRTC category Ⅲ nodules. Conclusion C-TIRADS classification and BRAF^V600Etesting have great diagnostic efficacy in BSRTC category Ⅲ nodules, and the combination of two methods can improve the diagnostic sensitivity and negative predictive value, suggesting the great value in differentiating BSRTC categoryⅢ nodules.更多还原