The Combination of BRAFV600E mutation and Chinese Thyroid Imaging Reporting and Data System is Helpful in the Management of AUS/FLUS Thyroid Nodules

Abstract Purpose To explore the utility of the BRAFV600E mutation in combination with 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. Malignant TNs were more commonly observed in TNs with a size less than 10mm (P = 0.033). 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 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). The diagnostic performance of C-TIRADS was similar to the BRAFV600E mutation (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 TNs. The combination can be helpful in selecting appropriate management for AUS/FLUS patients.