探究BRAF V600E基因和美国放射学会（ACR）甲状腺影像报告和数据系统（TI-RADS）分类对Bethesda Ⅲ类甲状腺结节的风险评估价值。

回顾性分析2019年4月至2022年4月在中日友好医院行超声引导下细针穿刺细胞学检查且有手术病理结果的Bethesda Ⅲ类结节127个，根据病理结果将结节分为良性组（19个）和恶性组（108个）。采用χ²检验比较Bethesda Ⅲ类结节良、恶性组BRAF基因检测结果及ACR TI-RADS分类差异，比较2种方法单独及联合对Bethesda Ⅲ类结节的诊断效能，并用BRAF基因和ACR TI-RADS分类对Bethesda Ⅲ类结节进行恶性风险分层管理。

BRAF基因诊断Bethesda Ⅲ类结节的敏感度、特异度、准确性分别为47.2%、100%、55.1%，ACR TI-RADS分类的敏感度、特异度、准确性分别为81.5%、68.4%、79.5%，BRAF基因联合ACR TI-RADS分类的敏感度、特异度、准确性分别为92.6%、68.4%、89.0%，二者联合诊断的敏感度和准确性高于ACR TI-RADS分类，差异有统计学意义（χ²=10.08、4.27，P=0.002、0.039）。BRAF基因阳性的Bethesda Ⅲ类结节恶性率为100%，建议手术治疗。BRAF基因阴性Bethesda Ⅲ类结节中，ACR TI-RADS 3类结节恶性率为0，建议随访观察，ACR TI-RADS 4类结节恶性率为44.4%，建议重复穿刺活检，ACR TI-RADS 5类结节恶性率为89.1%，建议手术治疗。

BRAF V600E 基因联合ACR TI-RADS分类能够提高Bethesda Ⅲ类结节良恶性诊断的敏感度和准确性，能够实现对Bethesda Ⅲ类结节风险分层并指导临床处置。

To evaluate the value of BRAF V600E mutation and American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) classification in risk assessment of Bethesda Ⅲ thyroid nodules.

A retrospective analysis was conducted on 127 Bethesda category Ⅲ nodules in patients who underwent fine needle aspiration cytology (FNA) and subsequent surgical pathology examination at China-Japan Friendship Hospital from April 2019 to April 2022. According to pathological findings, the nodules were divided into either a benign group (n=19) or a malignant group (n=108). The Chi-square test was used to compare the differences in the BRAF gene test results and ACR TI-RADS classification between benign and malignant groups of Bethesda category Ⅲ nodules. The diagnostic efficacy of BRAF gene mutation and ACR TI-RADS classification, individually and combined, for Bethesda category Ⅲ nodules was compared, and a malignancy risk stratification for Bethesda category Ⅲ nodules was performed using the BRAF gene muatation and ACR TI-RADS classification.

The sensitivity, specificity, and accuracy of BRAF V600E mutation for diagnosing Bethesda category Ⅲ nodules were 47.2%, 100%, and 55.1%, respectively. The corresponding values for ACR TI-RADS classification were 81.5%, 68.4%, and 79.5%, respectively. The sensitivity, specificity, and accuracy of BRAF V600E mutation combined with ACR TI-RADS classification were 92.6%, 68.4%, and 89.0%, respectively. The combined method showed statistically significant higher sensitivity and accuracy compared to ACR TI-RADS classification alone (χ²=10.08 and 4.27; P=0.002 and 0.039, respectively). Bethesda category Ⅲ nodules with positive BRAF gene results had a 100% risk of malignancy and were recommended for surgical treatment. For BRAF-negative Bethesda category Ⅲ nodules, those with ACR TI-RADS 3 classification had a 0% malignancy rate and were recommended for follow-up observation, ACR TI-RADS 4 nodules had a 44.4% malignancy rate and were suggested for repeat FNA, and ACR TI-RADS 5 nodules had an 89.1% malignancy rate and were recommended for surgical treatment.

The combination of BRAF V600E mutation with ACR TI-RADS classification improves the diagnostic sensitivity and accuracy for Bethesda category Ⅲ nodules and facilitates risk stratification and clinical management of these nodules.