Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico "P. Giaccone", University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy.
Unit of Oncological Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy.
Medicina (Kaunas). 2023 Aug 17;59(8):1484. doi: 10.3390/medicina59081484.
: 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. : 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. : 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. : 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.
贝塞斯达分类法 3 级（BIII）甲状腺结节的恶性肿瘤发生率为 5-15%。我们的目的是评估哪些超声标准与癌症风险最相关，以及关键超声（US）重新评估的价值。
从 2018 年到 2022 年，共有 298 个 BIII 结节被纳入甲状腺切除术（79 例恶性肿瘤）。我们评估了超声数据：回声性质、瘤内血管化、刺状边缘、微钙化、“高宽比”形状、甲状腺外生长、大小增加，以及它们与组织学的关系。我们还评估了超声重新评估是否改变了治疗策略。
刺状边缘和微钙化与恶性肿瘤风险显著相关。刺状边缘的特异性为 0.95 IC95%（0.93-0.98）；敏感性为 0.70 IC95%（0.59-0.80）。微钙化的敏感性为 0.87 CI95%（0.80-0.94）；特异性为 0.75 CI95%（0.72-0.83）。这些征象的存在在 76/79 例病例中重新调整了治疗策略。然后，在 75%的病例中，手术指征是合适的。
微钙化和刺状边缘应在 BIII 结节的最终超声重新评估中常规寻找。这些征象使得在 96%的未进行手术的病例中，修改了手术策略。证实了在 BIII 甲状腺结节评估中整合超声和细胞学的重要性。BIII 结节的超声重新评估允许重新定向手术选择。
