Predictors of Malignancy in Thyroid Nodules Classified as Bethesda Category III

Liu, Xiaoli; Wang, Jingjing; Du, Wei; Dai, Lan; Fang, Qigen

doi:10.3389/fendo.2022.806028

Cited by 6 publications

(10 citation statements)

References 25 publications

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“…Most of the data reported about the rates of ROM in the literature are the results of the studies performed before the era of NIFTP and ranges between 17.0 [ 15 ] and 83.1% [ 16 ]. Liu et al [ 8 ] excluded NIFTP from the malignant diagnostic category and informed ROM as 54.3% in their study. In the present study, histological diagnostic categories were created according to the 5th edition (Beta version) of the WHO Classification of Endocrine and Neuroendocrine Tumours [ 28 ], and NIFTP was categorized as a LRN and was not considered a malignant tumor in the calculation of ROM.…”

Section: Discussionmentioning

confidence: 99%

“…In this context, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a worldwide accepted reporting system for thyroid FNAs since the first edition reported following National Cancer Institute “Thyroid FNA State of the Science Conference” held in Bethesda, MD, in October of 2007 [ 7 ]. TBSRTC was developed to standardize the diagnostic terminology of thyroid cytopathology and consists of six categories, each of which indicates a particular risk of malignancy (ROM) which ensures that patients benefit from appropriate clinical management by using the same language between the pathologist and the surgeon or endocrinologist [ 6 , 8 ]. However, significant interobserver variabilities exist for indeterminate categories due to the subjective morphological interpretation.…”

Section: Introductionmentioning

confidence: 99%

“…Many authors have emphasized subcategorizing AUS category due to their wide range of malignancy risk and the heterogeneous nature of the category, and they have reported higher rates of malignancy in AUS with nuclear or cytological atypia than AUS with architectural atypia [ 8 , 16 – 27 ]. And finally, two-tiered subcategorization of AUS including AUS “nuclear” and AUS “other” is recommended in the recent 3rd edition of TBSRTC [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Comprehensive Approach to the Thyroid Bethesda Category III (AUS) in the Transition Zone Between 2nd Edition and 3rd Edition of The Bethesda System for Reporting Thyroid Cytopathology: Subcategorization, Nuclear Scoring, and More

Bagıs,

Can,

Sut

et al. 2024

Endocr Pathol

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Significant interobserver variabilities exist for Bethesda category III: atypia of undetermined significance (AUS) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Thus, subcategorization of AUS including AUS “nuclear” and AUS “other” is proposed in the recent 3rd edition of TBSRTC. This study investigated the impact of the nuclear features/architectural features/nuclear score (NS) (3-tiered)/subcategories and subgroups on risk of malignancy (ROM) in thyroid fine-needle aspirations (FNA). 6940 FNAs were evaluated. 1224 (17.6%) cases diagnosed as AUS were reviewed, and 240 patients (initial FNAs of 260 nodules and 240 thyroidectomies) were included. Subcategories and subgroups were defined according to TBSRTC 2nd and 3rd editions. Histological diagnostic groups included nonneoplastic disease, benign neoplasm, low-risk neoplasm, and malignant neoplasm. Overall, ROM was 30.7%. ROM was significantly higher in FNAs with nuclear overlapping (35.5%), nuclear molding (56.9%), irregular contours (42.1%), nuclear grooves (74.1%), chromatin clearing (49.4%), and chromatin margination (57.7%), and these features were independent significant predictors for malignancy. FNAs with NS3 had significantly higher ROM (64.2%). Three-dimensional groups were significantly more frequent in malignant neoplasms (35.7%). ROM was significantly higher in AUS-nuclear subcategory (48.2%) and in AUS-nuclear and architectural subcategory (38.3%). The highest ROM was detected in AUS-nuclear1 subgroup (65.2%). ROM was significantly higher in the group including AUS-nuclear and AUS-nuclear and architectural subcategories, namely “high-risk group” than the group including other subcategories, namely “low-risk group” (42.0%vs 13.9%). In conclusion, subcategorization may not be the end point, and nuclear scoring and evaluation of architectural patterns according to strict criteria may provide data for remodeling of TBSRTC categories.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Comprehensive Approach to the Thyroid Bethesda Category III (AUS) in the Transition Zone Between 2nd Edition and 3rd Edition of The Bethesda System for Reporting Thyroid Cytopathology: Subcategorization, Nuclear Scoring, and More

Bagıs,

Can,

Sut

et al. 2024

Endocr Pathol

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“…26 Our study appears to have a broader scope than many previous studies on AUS. While prior research has primarily focused on clinical and ultrasound (USG) variables or demographic and pathological variables, [27][28][29][30][31] in this study includes a comprehensive examination of clinical, USG, and cytopathological (not routinely examined, all presented in Tables 1 and 2) variables. This comprehensive approach could potentially provide a more detailed understanding of AUS.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic models for predicting malignancy in thyroid nodules classified as Bethesda Category III in an endemic region

Kasap,

Kurt,

Özsağır

et al. 2024

Diagnostic Cytopathology

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BackgroundThis study aims to develop a diagnostic model to help physicians determine whether thyroid nodules categorized as atypia of undetermined significance (AUS) in category III of the Bethesda system are benign or malignant preoperatively. To create a diagnostic model for predicting thyroid nodules' benign or malignant with AUS cytology based on clinical, ultrasonographic, and cytopathological findings.MethodsThis is a retrospective cohort study involving patients (>19) at risk of thyroid cancer who had thyroidectomy after an AUS cytology. The dataset consists of 53 variables 204 nodules from 183 patients. Binary logistic regression and factor analysis methods were used to identify risk factors for malignancy. Finally, four prediction models were developed using different approaches, based on clinical, pathological clinical + pathological, and the factors.ResultsA total of 88 (48.1%) of 183 patients diagnosed with AUS were benign and 95 (51.9%) the malignant. After determining risk factors, four prediction models were developed based on different approaches to assist physicians in deciding to detect AUS nodules early. It was seen that bilaterality was found to be a risk factor for malignancy in the clinical model (pbilaterality = .03) and it was also seen that the pathological variables pale chromatin and irregular contours in the oncocyte variables were risk factors for malignancy (ppalechromatin = .02, pirregularcontoursintheoncocyte = .04). The best model obtained sensitivity and specificity values are 73% and 87% based on clinical and pathological variables.ConclusionThis comprehensive study may provide a more in‐depth understanding of AUS and make a notable contribution to healthcare professionals before surgery.

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“…Microcalcification is a consistent predictor of thyroid malignancy and is a part of TIRADS [ 8 ]. Among Bethesda III nodules, microcalcification is one of the strong predictors of malignancy and helps in decision-making for surgery [ 25 ]. Hence, the presence of microcalcification and suspicious cervical lymph nodes on neck ultrasound should prompt a potential sampling error even if FNAC is reported for Bethesda II.…”

Section: Discussionmentioning

confidence: 99%

High Malignancy Risk and Its Predictors in South Indian Patients With Bethesda II Thyroid Nodules

Tirupati,

Puthenveetil,

Lakkundi

et al. 2024

Cureus

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Background: Global data reports a low malignancy risk, whereas regional data report a variable risk of malignancy in Bethesda II thyroid nodules. The limited availability of surgical histopathology might have underestimated the risk of malignancy. Here, we report the prevalence of malignancy and its predictors in Bethesda II thyroid nodules for which the surgical histopathological diagnosis was available. Methods: This retrospective study was done at a tertiary healthcare center in South India between January 2008 and September 2015. Case records of adults with thyroid nodules who underwent surgery were collected. Patients with inadequate data were excluded from the study. The data was analyzed using SPSS version 21.0 and a p-value of < 0.05 was considered statistically significant. Results: A total of 563 patients were included in the study with a mean age of 36±12 years. Serum thyrotropin (TSH) was low in 87 (15.4%) patients whereas 362 (64.2%) patients had multinodular goiter (MNG). Sonographic evidence of suspicious cervical lymph node and microcalcification was seen in four (0.7%) and 48 (8.5%) patients, respectively. A total of 48 (8.5%) patients had thyroid carcinoma in the final histopathology. Of these, 42 (87.5%) had papillary thyroid carcinoma, five (10.4%) had follicular thyroid carcinoma and one (4.1%) had anaplastic carcinoma. Age, gender, and maximum nodule size were not associated with malignancy. Thyrotoxicosis was negatively associated with malignancy whereas multi-nodularity, thyroid calcification, or suspicious cervical lymph node on ultrasound and total thyroidectomy were positively associated with malignancy on univariate analysis. On binary logistic regression, only the former four, but not total thyroidectomy, were independent predictors of malignancy. Conclusions: We report a high (8.5%) prevalence of malignancy among South Indian patients with Bethesda II thyroid nodules. Thyroid microcalcification, presence of suspicious cervical lymph node on ultrasound, and multinodularity were associated with high and suppressed TSH with low risk of malignancy. Further prospective studies are warranted to confirm the study observations.

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Predictors of Malignancy in Thyroid Nodules Classified as Bethesda Category III

Cited by 6 publications

References 25 publications

A Comprehensive Approach to the Thyroid Bethesda Category III (AUS) in the Transition Zone Between 2nd Edition and 3rd Edition of The Bethesda System for Reporting Thyroid Cytopathology: Subcategorization, Nuclear Scoring, and More

A Comprehensive Approach to the Thyroid Bethesda Category III (AUS) in the Transition Zone Between 2nd Edition and 3rd Edition of The Bethesda System for Reporting Thyroid Cytopathology: Subcategorization, Nuclear Scoring, and More

Diagnostic models for predicting malignancy in thyroid nodules classified as Bethesda Category III in an endemic region

High Malignancy Risk and Its Predictors in South Indian Patients With Bethesda II Thyroid Nodules

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