The Value Of Ultrasonography、FNAC And Thyroid-cancer-21-gene Detection In The Diagnosis Of Benign And Malignant Thyroid Nodules

Objective(s):1.To explore the diagnostic value of Kwak-TIRADS and C-TIRADS for thyroid nodules;2.To explore the value of Fine Needle aspiration cytology(FNAC),BRAF,and thyroid-cancer-21-gene detection in the diagnosis of benign and malignant nodules of the thyroid and the diagnostic utility of C-TIRADS in combination with FNAC,BRAF,and thyroid-cancer-21-gene;3.To explore the value of BRAF and thyroid-cancer-21-gene in cytologically uncertain thyroid nodules.Methods:A retrospective analysis was conducted on data from 124 patients with 129 thyroid nodules who underwent thyroid ultrasonography,FNAC,genetic testing and surgical treatment at the Third Affiliated Hospital of Kunming Medical University between March 1,2019 and March 31,2022.This study analyzed the relationship between clinical and ultrasound features and benign and malignant nodules using postoperative histopathology as the gold standard.The detection sensitivity(Se),specificity(Spe),positive predictive value(PPV),negative predictive value(NPV),and accuracy(Acc)of ultrasonography,FNAC,BRAF,thyroid-cancer-21-gene and ultrasonography combined with FNAC,BRAF/thyroid-cancer-21-gene were determined.To compare the diagnostic efficacy,the ROC curve was plotted and the AUC was calculated.The Se,Spe,PPV,NPV,and Acc of BRAF and thyroid-cancer-21-gene in cytologically indeterminate nodules were calculated.Results:1.Out of the 129 thyroid nodules,9 were found to be benign and 120 were malignant.There was no significant difference in gender and age between the benign and malignant groups(P > 0.05).However,significant statistical differences were observed in the components of thyroid nodules,internal echoes,and margins(P <0.05).2.The optimal cut-off values for Kwak-TIRADS and C-TIRADS are 4C and 4B,respectively.The corresponding Se,Spe,PPV,NPV,Acc,AUC for Kwak-TIRADS4 C are 94.17%,55.56%,96.58%,41.67%,91.47%,and 0.749.For C-TIRADS 4B,the values are 98.33%,44.44%,95.93%,66.67%,94.57%,and 0.714.3.(1)Se,Spe,PPV,NPV,Acc,AUC of FNAC,BRAF,and thyroid-cancer-21 genes were 91.67%,44.44%,28.57%,86.96%,0.681 and 72.50%,88.89%,98.86%,19.51%,73.64%,0.807 and 81.66%,33.33%,93.33%,12.00%,78.29%,0.575.(2)Ultrasonography has the highest sensitivity and diagnostic accuracy as a single diagnostic method,and is the most effective screening method.The area under the curve of BRAF is 0.807,which can be used as an effective supplementary method of US;when combined diagnosis,Se,Spe,PPV,NPV,Acc,AUC of US+FNAC+BRAF and US+FNAC+thyroid-cancer-21-genes were 100%,22.22%,94.49%,100%,94.57%,0.611 and 100%,11.11%,93.75%,100%,93.80%,0.556,respectively.The combined diagnosis of the three methods is beneficial to the detection of malignant nodules.4.The Se,Spe,PPV,NPV,and Acc of BRAF and thyroid-cancer-21-genes in the diagnosis of cytologically indeterminate thyroid nodules were 50.00%,100%,100%,42.86%,63.64%,and 75%,33.33%,75%,respectively.33.33%,63.64%.Conclusion(s):1.Both Kwak-TIRADS and C-TIRADS have high diagnostic value for thyroid nodules;2.Combined diagnosis of US,FNAC,BRAF/thyroid-cancer-21 genes has higher sensitivity and negative predictive value than single diagnostic method;The use can significantly improve the detection rate of malignant thyroid nodules;3.In cytologically indeterminate thyroid nodules,the detection of BRAF and thyroid cancer 21 genes is helpful for the detection of malignant nodules.