Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
Korean J Radiol. 2024 Oct;25(10):924-933. doi: 10.3348/kjr.2024.0292.
This study aimed to evaluate the performance of an integrated risk stratification system (RSS) based on ultrasound (US) RSSs, nodule size, and cytology subcategory for diagnosing malignancy in thyroid nodules initially identified as Bethesda category III on fine-needle aspiration.
This retrospective study was conducted at two institutions and included consecutive patients with Bethesda category III nodules, and final diagnoses confirmed by repeat biopsy or surgery. A total of 320 Bethesda category III nodules (≥1 cm) from 309 patients (223 female and 86 male; mean age, 50.9 ± 12.0 years) were included. The malignancy risk of Bethesda category III nodules and predictors of malignancy were assessed according to US RSSs, nodule size, and cytology subcategory. The diagnostic performances of US-size cytology (USC) RSS and US RSS alone for malignancy were compared.
The intermediate or high suspicion US category independently increased the malignancy risk in all US RSSs ( ≤ 0.001). Large nodule size (≥3 cm) independently increased the malignancy risk of low- or intermediate suspicion US category nodules. Additionally, the atypia of undetermined significance cytology subcategory independently increased the malignancy risk of low suspicion US category nodules in most US RSSs. The area under the receiver operating characteristic curve of the USC RSSs was greater than that of the US RSSs alone ( < 0.048). Malignancy was not found in the very low risk category of USC RSS.
The diagnostic performance of USC RSS for malignancy was superior to that of US RSS alone in Bethesda category III nodules. Malignancy can be ruled out in the very low-risk category of USC RSS.
本研究旨在评估一种基于超声（US）风险分层系统（RSS）、结节大小和细胞学亚分类的综合风险分层系统（RSS）在经细针抽吸后最初被诊断为 Bethesda 分类 III 的甲状腺结节中诊断恶性肿瘤的性能。
本回顾性研究在两个机构进行，纳入了连续的 Bethesda 分类 III 结节患者，最终诊断通过重复活检或手术证实。共纳入 309 例患者的 320 个 Bethesda 分类 III 结节（≥1cm）（223 例女性，86 例男性；平均年龄 50.9±12.0 岁）。根据 US RSS、结节大小和细胞学亚分类评估 Bethesda 分类 III 结节的恶性风险和恶性肿瘤的预测因素。比较了 US-大小细胞学（USC）RSS 和单独使用 US RSS 对恶性肿瘤的诊断性能。
中间或高度可疑的 US 类别独立增加了所有 US RSS 中的恶性风险（≤0.001）。大结节大小（≥3cm）独立增加了低或中可疑 US 类别的结节的恶性风险。此外，在大多数 US RSS 中，不明确意义的细胞学亚类的不典型性独立增加了低可疑 US 类别的结节的恶性风险。USC RSS 的受试者工作特征曲线下面积大于单独使用 US RSS（<0.048）。在 USC RSS 的极低风险类别中未发现恶性肿瘤。
在 Bethesda 分类 III 结节中，USC RSS 对恶性肿瘤的诊断性能优于单独使用 US RSS。在 USC RSS 的极低风险类别中可以排除恶性肿瘤。
