The Novel And Practical Score Systems In Diagnosis Of Thyroid Nodules

Objective : Clinical management of patients with thyroid nodules indeterminate at fine-needle aspiration cytology(FNAC) is still unsettled. BRAF V600 E mutation also has dubious diagnostic value due to its low sensitivity. Novel strategies are in urgent need to detect the majority of thyroid malignancies from thyroid nodules.Methods: The prospective study included 504 thyroid nodules diagnosed by ultrosonography(US) from 468 patients, and FNAC was performed under ultrasound guidance. FNAC and molecular analysis including BRAF V600 E, RET/PTC1 and RET/PTC3 were conducted simultaneously. The cytology and US results together with mutational status were gathered and analyzed. The predictable score systems were designed using a combination of diagnostic parameters for US, FNAC, and genetic analysis. The utility value of score systems were analyzed and contrasted with above single detection means.Results: By means of the score systems, the sensibility were almost identical for score system~a(US, FNAC, BRAF V600 E, RET/PTC) and score system~b(US, FNAC, BRAF V600E) about 91.0% and 90.2%, respectively, which were significantly higher than above single detection means, respectively 63.9%, 70.7% and 87.2% for FNAC, genetic analysis and US. The score systemc(US, FNAC) was slightly inferior to the former two score systems, but still had relatively high sensitivity and specificity(80.5% and 95.1%), which significantly superior to single FNAC, US or genetic analysis. In nodules with uncertainty cytology, score system~a, score system~b and score systemc all could elevate detection rate of malignancy to 69.7%, 69.7% and 63.6%, respectively.Conclusion: These three score systems were brief to master for clinicians and could provide quantified information for the probability of malignant nodules. The score system~b was recommended to improve the detection rate in uncertainty nodules.