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The combination of BRAFV600E mutation and Chinese Thyroid Imaging Reporting and Data System is helpful in the management of AUS/FLUS thyroid nodules

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Abstract

Purpose

To explore the utility of the BRAFV600E mutation in combination with the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) in the management of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) thyroid nodule (TN).

Methods

138 AUS/FLUS TNs in 129 patients were included. Each TN underwent preoperative BRAFV600E mutation analysis and was classified using the C-TIRADS. Histopathologic diagnosis served as reference standard.

Results

46 benign TNs and 92 malignant TNs were identified. The C-TIRADS 4C and 5 (OR = 10.409, P = 0.000), BRAFV600E mutation (OR = 36.493, P = 0.000) were independent predictors of malignant nodules. There were significant differences in malignancy rate among the different C-TIRADS TNs (P = 0.000), and these TNs with higher C-TIRADS were associated with increased malignancy rate (P for trend = 0.000). The rate of the nodule with BRAFV600E mutation increased with the increase of C-TIRADS (P for trend = 0.001). For AUS/FLUS TNs without BRAFV600E mutation, the malignancy rates of the C-TIRADS 3, 4A, 4B, 4C, and 5 were 0%, 21.4%, 20.8%, 70.8%, and 100%, respectively (P = 0.000), and the malignancy rate increased from C-TIRADS 3 to C-TIRADS 5 (P for trend = 0.000). C-TIRADS and BRAFV600E mutation had similar diagnostic efficacy (P > 0.05), and the sensitivity, negative predictive value, and accuracy of the combination were significantly higher than BRAFV600E gene or C-TIRADS alone (P < 0.05).

Conclusions

C-TIRADS can effectively provide risk stratification for AUS/FLUS nodules. The combination is helpful in selecting appropriate management for AUS/FLUS patients.

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Data availability

All data generated or analyzed during this study are included in this article.

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Funding

This study was supported by the Zhejiang Province Natural Science Foundation (grant no. LY20H180005) which is gratefully acknowledged.

Author information

Authors and Affiliations

  1. Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China

    Qiang Li, Lu Yang, Jianghong Lv, Lilong Xu & Shiyan Li

  2. Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China

    Murui Zhang

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  1. Qiang Li
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Q.L., L.Y., J.L., L.X., M.Z. The first draft of the manuscript was written by Q.L. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Shiyan Li.

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The authors declare no competing interests.

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This study was approved by the board of medical ethics of Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine.

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Written informed consents were obtained from all participants included in the study.

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Li, Q., Yang, L., Lv, J. et al. The combination of BRAFV600E mutation and Chinese Thyroid Imaging Reporting and Data System is helpful in the management of AUS/FLUS thyroid nodules. Endocrine 78, 507–516 (2022). https://doi.org/10.1007/s12020-022-03176-8

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