THE DIAGNOSTIC VALUE OF US-FNAB COMBINED WITH BRAF V600E GENE MUTATION DETECTION IN TI-RADS CATEGORY 4 THYROID NODULES

Abstract Objectives This study aims to evaluate the diagnostic value of US-FNAB and BRAF V600E gene mutation testing for thyroid nodules of TI-RADS category 4, including subcategories 4a, 4b, and 4c, and to provide a reference for guiding surgeons in formulating individualized treatment plans for patients. Methods A retrospective analysis was conducted on 685 patients with TI-RADS category 4 thyroid nodules who underwent thyroid ultrasound, US-FNAB, and BRAF V600E gene mutation testing from January 2018 to December 2022 at Shandong Provincial Hospital Affiliated to Shandong First Medical University. TI-RADS classification was based on ultrasound images. Patients were classified based on Bethesda cytological results as negative (Bethesda IV or lower) or positive (Bethesda V or higher). The final diagnosis was based on postoperative pathology. Results Among the 685 patients, 653 had malignant tumors, and 32 had benign tumors. The sensitivity, specificity, positive predictive value, and negative predictive value of the combined diagnostic approach were higher than those of the independent methods, particularly for TI-RADS 4c nodules. Conclusions Combining US-FNAB and BRAF V600E gene mutation testing improves diagnostic efficiency for TI-RADS category 4 thyroid nodules, especially for TI-RADS 4c nodules, leading to higher preoperative diagnostic rates and better guidance for clinical decisions regarding further treatment.