Bethesda III Thyroid Nodules: The Role of Ultrasound in Clinical Decision Making

Norlén, Olov; Popadich, Aleksandra; Kruijff, Schelto; Gill, Anthony J.; Sarkis, Leba M.; Delbridge, Leigh; Sywak, Mark; Sidhu, Stan

doi:10.1245/s10434-014-3749-8

Cited by 12 publications

(11 citation statements)

References 15 publications

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“…Conversely, in one study including only nodules with Bethesda III cytology, echogenicity showed the highest IRR among other 5 individual features, with k value of 0.94. Notably all other features had moderate to substantial agreement as well [26]. Along with the results of our study, it could be suggested that this disparity is explained by the fact that nodules with Bethesda III cytology are a subset with more homogenous US characteristics.…”

Section: Discussionsupporting

confidence: 71%

“…In our study, the IRR for echogenicity was substantial with kappa value of 0.71. In previous cohorts of no specific subsets of thyroid nodules, echogenicity was consistently among the features with lower IRR (0.33-0.57) showing only fair to moderate agreement [3,[18][19][20][21][22][23][24][25][26]. Conversely, in one study including only nodules with Bethesda III cytology, echogenicity showed the highest IRR among other 5 individual features, with k value of 0.94.…”

Section: Discussionmentioning

confidence: 84%

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Inter-Reader Agreement of ATA Sonographic Risk in Thyroid Nodules with Bethesda Category III Indeterminate Cytology

et al. 2021

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Background: Substantial inter-observer variation has been documented in the recognition and description of specific sonographic features as well as for ATA sonographic risk (ASR). This raises the question if the risk stratification proposed by the ATA guidelines is reproducible and applicable for nodules with indeterminate cytology. The aim of the study was to determine the inter-reader agreement (IRR) among radiologists using the 2015 ASR stratification in indeterminate thyroid nodules. Methods: Three board certified radiologists who were blinded to clinical data and to each other, interpreted the ultrasound findings of 179 nodules that had Bethesda III cytology. The nodules were classified into high suspicion (HS), intermediate (IS), low (LS), very low (VLS). Echogenicity, composition, shape taller than wide, vascularity, type of margins, presence and type of calcifications were also described. Results: The majority consensus revealed that 28%, 27%, 39% and 5% were described as high, intermediate, low and very low ASR, respectively. The inter-reader agreement was near perfect (k 0.82 CI 95% (0.77–0.87)). Nodules were paired into a higher risk (HS + IS) and lower risk (LS + VLS) categories with substantial agreement (k 0.7) in both categories. Conclusion: A near perfect agreement among readers was observed when stratifying indeterminate cytology nodules for ASR.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 84%

Inter-Reader Agreement of ATA Sonographic Risk in Thyroid Nodules with Bethesda Category III Indeterminate Cytology

et al. 2021

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“…In the original report of the BSRTC, the risk of malignancy has been reported as 5-15%, 15-30%, and 60-75% for Bethesda III, IV, and V, respectively [4]. In literature, the overall malignancy rates varied from 9.3% to 48.9% for Bethesda III [2,6,9,[17][18][19][20]. Several authors proposed subcategorization or subgroupings based on the cytological findings of FNAB [18,20].…”

Section: Discussionmentioning

confidence: 99%

“…In the differential diagnosis of malignant thyroid nodules, various clinical and imaging methods can be used. Several ultrasonographic features such as microcalcifications, hypoechogenicity, irregularity, and being taller than wide can predict thyroid malignancy [ 6 , 7 ]. However, their use for predicting malignancy in indeterminate nodules is still questionable due to low specificity and accuracy [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Ultrasonographic Features for Thyroid Malignancy in Patients With Bethesda Categories III, IV, and V: A Retrospective Observational Study in a Tertiary Center

Hacım¹,

Akbaş²,

Ulgen³

et al. 2021

Cureus

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Introduction: Although fine-needle aspiration biopsy (FNAB) with cytologic interpretation using the Bethesda System for Reporting Thyroid Cytopathology has been widely used for thyroid nodules, its efficiency in Bethesda categories of III, IV, and V has been questioned due to variable risk of malignancy. We aimed to evaluate the impact of radiological parameters in Bethesda category III, IV, and V for thyroid malignancy.Methods: We performed a retrospective review of patients with Bethesda category III, IV, and V, and subsequent thyroidectomy. Demographic, ultrasonographic, and clinical variables were recorded. Independent variables for thyroid malignancy and the predictive power of imaging findings were analyzed.Results: There were 159 patients with a mean age of 48.1±13.4 years. Hypoechogenicity of the index nodule was the most common finding in 87 patients (54.7%). There were 74 (46.5%), 34 (21.4%), and 51 patients (32.1%) with Bethesda III, IV, and V categories, respectively. There were 91 patients (57.2%) with a diagnosis of thyroid malignancy. Overall malignant pathology was detected in 18 (24.3%), 25 (73.5%), and 48 patients (94.1%) in Bethesda III, IV, and V categories, respectively (p=0.001). The presence of solitary nodule, hypoechogenicity, and solid structure of index nodule and Bethesda category IV and V were significant variables for final malignant pathology (p<0.05 for all).Conclusion: Hypoechogenicity and solid structure in a solitary index nodule should be regarded as significant ultrasonographic findings for thyroid malignancy. Bethesda category IV and V were also significantly associated with malignancy.

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“…Furthermore, nodulectomy would not be considered in patients with either a family history of thyroid cancer or a history of previous head and neck irradiation. Recently, our unit has also demonstrated that a lack of hypoechogenic attenuation, irregular margins or microcalcifications on ultrasound has a high negative predictive value in excluding malignancy in Bethesda 3 nodules, making nodulectomy an attractive option in these cases . Clearly, there remains concern about the potential for complications, especially if the surgical procedure were to be undertaken by a less experienced surgeon.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive thyroid nodulectomy reduces post‐operative hypothyroidism when compared with thyroid lobectomy

Sarkis

Norlén

Sywak

et al. 2014

ANZ Journal of Surgery

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Bethesda III Thyroid Nodules: The Role of Ultrasound in Clinical Decision Making

Abstract: HA, IM, and MC were predictors of malignancy in Bethesda III nodules. In addition, the negative predictive value for any of these three criteria was high; a nodule that lacks all of these three criteria is thus unlikely to be malignant.

Cited by 12 publications

References 15 publications

Inter-Reader Agreement of ATA Sonographic Risk in Thyroid Nodules with Bethesda Category III Indeterminate Cytology

Inter-Reader Agreement of ATA Sonographic Risk in Thyroid Nodules with Bethesda Category III Indeterminate Cytology

Impact of Ultrasonographic Features for Thyroid Malignancy in Patients With Bethesda Categories III, IV, and V: A Retrospective Observational Study in a Tertiary Center

Minimally invasive thyroid nodulectomy reduces post‐operative hypothyroidism when compared with thyroid lobectomy

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