探讨超声甲状腺影像报告与数据系统（TIRADS）联合BRAF^V600E检测对甲状腺细胞病理学Bethesda报告系统（BSRTC）Ⅲ类结节的诊断价值。

选取2016年1月至2019年6月在南京医科大学第一附属医院行超声引导下甲状腺FNA的患者125例，共125个BSRTC Ⅲ类结节。所有结节同时行TIRADS分类和BRAF^V600E检测，并经手术病理证实。以手术病理结果为金标准，比较TIRADS、BRAF^V600E检测及两者联合对BSRTC Ⅲ类甲状腺结节的诊断价值。

125例患者共计纳入125个甲状腺结节，术后病理结果提示：良性结节76个；恶性结节49个。TIRADS 4c~5鉴别诊断BSRTC Ⅲ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为73.5%、89.5%、81.8%、84.0%、83.2%。BRAF^V600E突变检测鉴别BSRTC Ⅲ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为75.5%、100.0%、100.0%、86.4%、90.4%。以TIRADS 4c~5类或BRAF^V600E突变型为BSRTC Ⅲ类结节恶性的联合诊断标准，其敏感度、特异度、阳性预测值、阴性预测值及准确性分别为93.9%、89.5%、85.2%、95.8%、91.2%，联合诊断较TIRADS、联合诊断较BRAF^V600E具有较高的敏感度（P=0.002，P=0.004）、阴性预测值（P=0.018，P=0.044）。

TIRADS和BRAF^V600E检测联合对于BSRTC Ⅲ类结节具有良好的诊断效能，尤其诊断敏感度和阴性预测值高于单独应用TIRADS或BRAF^V600E检测。

To assess the diagnostic value of the thyroid imaging reporting and data system (TIRADS) combined with BRAF^V600E testing in Bethesda system category Ⅲ thyroid nodules.

A total of 125 patients who underwent ultrasound-guided fine needle aspiration (FNA) at the First Affiliated Hospital of Nanjing Medical University from January 2016 to June 2019 were selected. Each nodule underwent TIRADS classification and BRAF^V600E testing and was confirmed by histopathology. The diagnostic efficacy of TIRADS, BRAF^V600E testing, and their combination were assessed according to histopathology findings.

A total of 125 nodules from 125 patients were enrolled. According to histopathology findings, 76 nodules were benign and 49 were malignant. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of TIRADS 4c or 5 were 73.5%, 89.5%, 81.8%, 84.0%, and 83.2%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of BRAF^V600E mutation were 75.5%, 100.0%, 100.0%, 86.4%, and 90.4%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of the combination of TIRADS 4c or 5 and BRAF^V600E mutation were 93.9%, 89.5%, 85.2%, 95.8%, and 91.2%, respectively. The combination of TIRADS 4c or 5 and BRAF^V600E mutation significantly increased the sensitivity (P=0.002, P=0.004) and NPV (P=0.018, P=0.044) when compared with either TIRADS or BRAF^V600E mutation alone.

Our findings suggest that the combination method has improved sensitivity and NPV and may have great value in differentiating Bethesda system category Ⅲ nodules.