Improving Diagnostic Performance for Thyroid Nodules Classified as Bethesda Category III or IV: How and by Whom Ultrasonography Should be Performed

Abstract

Background: The purpose of this prospective study is to evaluate if the association of Bethesda system and a 3-categories Ultrasonography (US) risk stratification system proposed by the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi improves the performance of cytology alone in III or IV categories and if further variables such as US provider (radiologist; endocrinologist, or endocrine surgeon both coming from a dedicated team) influence the accuracy of the diagnostic.Methods: 570 consecutive patients with complete clinical records, affected by Bethesda III or IV nodules, have been addressed to two public referral surgical centers of Western Sicily. Age, sex, autoimmunity, nodule size, and US provider were recorded. Fisher's exact test was used for the univariate analysis; Odd's ratios were calculated for the multivariate analysis.Results: 248 patients had malignancy at histology, 322 were benign. The mean age was 52 years for the malignancy group and 58 y for the benign group (P < 0.001). At univariate analysis, autoimmunity was correlated with benign group (P < 0.001), and US risk 2 and 3 Author's contribution: material preparation was performed by D.L.B. and J.L.; data collection was performed by G.M., G.O., and A.C.; data analysis was performed by S.M. The first draft of the manuscript was written by C.C.; G.S.. G.C. contributed in study conception and design, final draft revision for final approval. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Authors Gregorio Scerrino e Gianfranco Cocorullo have contributed equally to this work. Grant support for the research: none. Disclosure: the authors declare that they have no conflict of interest. Informed consent: Informed consent was obtained from all individual participants included in the study. Ethical board approval: obtained by "Comitato etico del Policlinico Paolo GiacconedPalermo".

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