Malignancy Rate of Bethesda Class III Thyroid Nodules Based on the Presence of Chronic Lymphocytic Thyroiditis in Surgical Patients

ObjectiveTo determine predictors of malignancy in surgically treated Bethesda category III nodules.MethodsPatients with surgically treated thyroid nodules classified as Bethesda category III were retrospectively enrolled. The association between clinical/sonographic features and postoperative pathology was evaluated using univariate and multivariate analyses.ResultsA total of 188 nodules from 184 patients were included. The overall malignancy rate was 54.3%. In univariate analysis, male sex, aspect ratio >1, microcalcification, unclear boundary, BRAFV600E mutation, and nuclear atypia were significantly associated with malignant disease in Bethesda category III nodules. Multivariate analysis confirmed that male sex, aspect ratio >1, microcalcification, and BRAFV600E mutation were independent predictors of malignant disease.ConclusionsMalignant disease was common in Bethesda category III nodules, and surgical treatment was strongly indicated in the presence of male sex, aspect ratio>1, microcalcification, and BRAFV600E mutation.

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“…A similar finding was also confirmed by Cho et al. ( 21 ), Erdogan-Durmus et al. ( 2 ), and in the present study.…”

Section: Discussionsupporting

confidence: 93%

Predictors of Malignancy in Thyroid Nodules Classified as Bethesda Category III

Liu

Wang

et al. 2022

Front. Endocrinol.

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“…In our study, the ultrasonographic signs that seem most associated with “critical” reassessment at a second ultrasonography, and most associated with carcinoma risk, were spiculated or microlobulated margins and microcalcifications. These findings correlate well with those of other studies, in which microcalcifications, nodule shape, margin irregularity, and hypoechogenicity were found to be variously correlated with increased risk of malignancy [ 12 , 27 , 47 , 48 ].…”

Section: Discussionsupporting

confidence: 91%

The Role of “Critical” Ultrasound Reassessment in the Decision-Making of Bethesda III Thyroid Nodules

Orlando,

Graceffa,

Mazzola

et al. 2023

Medicina

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Background and Objectives: Bethesda III (BIII) thyroid nodules have an expected malignancy rate of 5–15%. Our purpose was to assess which US criteria are most associated with cancer risk, and the value of critical ultrasound (US) reassessment. Methods: From 2018 to 2022, 298 BIII nodules were enrolled for thyroidectomy (79 malignancies). We evaluated ultrasonographic data: hechogenicity, intralesional vascularization, spiculated margins, micro-calcifications, “taller than wide” shape, extra-thyroidal growth, size increase, as well as their association with histology. We also evaluated if the ultrasound reassessment modified the strategy. Results: Spiculated margins and microcalcification were significantly correlated with malignancy risk. Spiculated margins showed a specificity of 0.95 IC95% (0.93–0.98); sensitivity 0.70 IC95% (0.59–0.80). Microcalcifications showed a sensitivity of 0.87 CI95% (0.80–0.94); specificity 0.75 CI95% (0.72–0.83). The presence of these signs readdressed the strategy in 76/79 cases Then, the indication for surgery was appropriate in 75% of cases. Conclusions: Microcalcifications and spiculated margins should be routinely sought during a final ultrasound reassessment in BIII nodules. These signs allowed for a modification of the strategy in favor of surgery in 96% of the cases that were not otherwise referred to surgery. The importance of integrating ultrasound and cytology in the evaluation of BIII thyroid nodules is confirmed. Reassessment with ultrasound of BIII nodules allowed for a redirection of the surgical choice.

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“…Their authors indicated that HT was not a risk factor for thyroid malignancy nodules with category III. Cho et al [38] found the same frequency of malignancy-48%-in patients with and without HT. Rotondi et al [39] also reported similar values-11.0% vs. 13.4%, respectively.…”

Section: Discussionmentioning

confidence: 80%

Hashimoto’s Thyroiditis Does Not Influence the Malignancy Risk in Nodules of Category III in the Bethesda System

Słowińska-Klencka

Popowicz

Klencki

2022

Cancers

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The aim of this study was to evaluate the risk of malignancy (RoM) in category III thyroid nodules of the Bethesda system in patients with and without Hashimoto thyroiditis (HT) and to analyze whether obtaining category III with a repeat FNA (rFNA) increases RoM. The study included 563 HT and 1250 non-HT patients; rFNA was performed in 349 and 575 patients, and surgical treatment in 160 and 390, respectively. There was no difference in RoM between HT and non-HT patients in the whole examined population (lower limit of RoM), nor in operated patients (upper limit of RoM), HT: 5.0–17.5%, non-HT: 4.7–15.1%. RoM in patients with AUS nodules (with nuclear atypia) was similar in both groups (HT: 21.7–40.0%, non-HT: 16.9–41.4%), as it was in patients with FLUS nodules (with architectural atypia) (HT: 3.5–13.3%, non-HT: 4.0–13.0%). In patients from both groups together, with category III diagnosed twice and AUS identified at least once, RoM was 16.7–50.0% and it was higher than that in patients with FLUS nodule diagnosed twice: 3.2–13.0% (p < 0.005). Concluding, RoM in category III nodules is not affected by the presence of HT. Subcategorization of category III nodules (FLUS vs. AUS) may provide guidance toward further follow-up or surgery in both groups.

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Malignancy Rate of Bethesda Class III Thyroid Nodules Based on the Presence of Chronic Lymphocytic Thyroiditis in Surgical Patients

Cited by 5 publications

References 30 publications

Predictors of Malignancy in Thyroid Nodules Classified as Bethesda Category III

Predictors of Malignancy in Thyroid Nodules Classified as Bethesda Category III

The Role of “Critical” Ultrasound Reassessment in the Decision-Making of Bethesda III Thyroid Nodules

Hashimoto’s Thyroiditis Does Not Influence the Malignancy Risk in Nodules of Category III in the Bethesda System

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