Diagnostic performance of combining sonographic features with BRAFV600E mutation for differentiating benign and malignant Bethesda category Ⅲ thyroid nodules

Abstract Objective To evaluate the diagnostic performance of combining sonographic features with BRAFV600E mutation for differentiating benign and malignant Bethesda category Ⅲ thyroid nodules. Methods This retrospective cohort study included 275 patients (278 nodules) diagnosed as Bethesda category Ⅲ by ultrasound-guided fine needle aspiration cytology (US-FNAC) at First Affiliated Hospital of Army Medical University between January 2020 and December 2024, with final confirmation via surgical pathology or repeated US-FNAC. Nodules were classified as benign or malignant based on pathological results. Diagnostic efficacy of age, sex, 9 sonographic features, ACR TI-RADS score, US-FNAC nuclear morphology, and BRAFV600E mutation was analyzed using multivariate logistic regression. Results Significant differences existed in age, nodule margin, aspect ratio, maximum diameter, echogenicity, Adler blood flow grading, ACR TI-RADS classification, US-FNAC nuclear morphology, and BRAFV600E status between benign and malignant nodules (all P