Objective:BethesdaSystemforReportingThyroidCytopathology(BSRTC)categoriesⅠ,Ⅲ,andⅤaccountforasignificantproportionoffineneedleaspirationcytology(FNAC)diagnoses.ThisstudyaimedtocomparethediagnosticefficacyofBRAFV600EmutationandtheThyroidImagingReportingandDataSystem(TIRADS)classificationindifferentiatingpapillarythyroidcancers(PTCs)frombenignlesionsamongBSRTCI,III,andVnodules.Methods:Atotalof472patientswith479noduleswereenrolledinthisprospectivestudy.Ultrasound,BRAFV600Emutationtesting,andFNACwereperformedineachnodule,followedbysurgeryorregularultrasoundexamination.Results:IntheBSRTCIcategory,BRAFV600Eshowedsimilarsensitivity,higherspecificity,andloweraccuracywhencomparedwithTIRADS.IntheBSRTCIII/Vcategory,thesensitivity,specificity,andaccuracyofBRAFV600EweresimilartothoseofTIRADS.IncomparisontoBRAFV600Ealone,thecombinationofthetwomethodssignificantlyimprovedsensitivity(BSRTCⅠ:93.6%vs.67.7%,P<0.01;BSRTCⅢ:93.8%vs.75.0%,P<0.01;BSRTCV:96.0%vs.85.3%,P<0.001).WhencomparedwithTIRADSalone,thecombinationimprovedsensitivityinBSRTCⅠnodules(93.6%vs.74.2%,P<0.05),increasedsensitivityanddecreasedaccuracyinBSRTCIIInodules(93.8%vs.75.0%,P<0.01,91.0%vs.93.6%,P<0.01),andimprovedbothsensitivityandaccuracyinBSRTCVnodules(96.0%vs.82.0%,P<0.001;94.2%vs.81.3%,P<0.001).Conclusions:BRAFV600EexhibitedhigherspecificityandloweraccuracycomparedwithTIRADSinBSRTCⅠnodules,whilethetwomethodsshowedsimilardiagnosticvalueinBSRTCⅢ/Ⅴnodules.ThecombinationofthetwomethodsdistinctlyimprovedsensitivityinthediagnosisofPTCsinBSRTCⅠ,Ⅲ,andⅤnodules.
