Reassessing Bethesda III and IV Thyroid Nodules: Insights from an Institution-based Malignancy Risk Analysis in a Cancer Center Setting
Raveena R. Nair, Sandeep Vijay, Anoop Attakkil, Sairu Philip, Karthickeyan Duraisamy, Kalpita Shringarpure, Vanithapriya Deenathayalan, Mohandoss MurugesanBackground:
Cytology categories Bethesda III and Bethesda IV thyroid nodules present a diagnostic challenge for both clinicians and patients owing to their heterogeneity and variable risk of malignancy (ROM). According to the Bethesda System, the estimated malignancy risk for these categories is 13%–30% and 23%–34%, respectively. However, institutional variations may exist. This study aimed to determine the ROM specific to our institution and to identify clinical factors associated with malignant outcomes.
Methodology:
This retrospective study included patients with Bethesda III and IV cytology who underwent thyroidectomy at a tertiary cancer center in Kerala between 2018 and 2022. Demographic, clinical, radiological, and histopathological data were analyzed. Statistical analyses were performed using Chi-square, Mann–Whitney
Results:
A total of 140 patients were included, the majority being females below 55 years of age. In the Bethesda III category, firm nodule consistency was significantly associated with malignancy (
Conclusion:
The malignancy rates for Bethesda III and IV nodules in our cohort were notably higher than those reported in the Bethesda system, emphasizing the need for institution-specific risk assessment. Firm to hard nodule consistency was strongly associated with malignancy, underscoring its value in clinical evaluation.