Combination of thyroid ultrasound examination (TIRADS) and survivin gene mRNA expression to determine the type of thyroid nodule

Abstract

Background: Ultrasound plays a significant role in determining the diagnosis of thyroid nodules. The thyroid ultrasound examination is operator dependent, so the Thyroid Imaging Reporting and Data System (TIRADS) method were developed. However, until now TIRADS has not been able to replace the Fine Needle Aspiration (FNA) examination in determining the type of benign or malignant thyroid nodule, so it is necessary to find alternative biomarkers that can be used to increase the sensitivity and specificity of TIRADS. In this study, the mRNA expression of the survivin gene in thyroid nodules was examined in combination with TIRADS so that it is expected to increase the diagnostic value. Method: This study is a diagnostic test with a cross sectional design on 51 patients with thyroid nodules in 5 hospitals on the island of Lombok. Subjects who met the inclusion and exclusion criteria were subjected to TIRADS examination using an ultrasound machine and mRNA expression of the survivin gene using cubital vein blood samples with polymerase chain reaction (PCR). Result: The characteristics of the research subjects were dominated by female sex with age 40 years, TIRADS 3 and histology of benign thyroid nodules. Analysis using the ROC curve obtained TIRADS has a sensitivity of 94.4%, specificity 39.4%, accuracy 58.82%, Positive Predictive Value (PPV) 45.9%, Negative Predictive Value (NPV) 92.9%. While Survivin has 100% sensitivity, 60.6% specificity, 58.1% accuracy, 58.1% PPV, 100% NPV. In the serial combination of TIRADS and survivin, there was an increase in the diagnostic value, namely sensitivity 94.4%, specificity 75.8%, accuracy 82.35%, PPV 68%, NPV 96.2%. Conclusion: The combination of TIRADS and survivin can increase the diagnostic value in determining the type of thyroid nodule