Unveiling the Malignancy Risk of Surgically Treated Bethesda III Thyroid Nodules: A 10-Year Retrospective Study Comparing Fine-Needle Aspiration Cytology (FNAC) and Histopathology.

Introduction Thyroid malignancy remains a significant global health concern, making the accurate differentiation between benign and malignant thyroid nodules crucial for optimal patient management. Fine-needle aspiration cytology (FNAC) is the gold-standard preoperative diagnostic tool, and The Bethesda System for Reporting Thyroid Cytopathology provides a standardized framework for interpretation. This 10-year retrospective study evaluated the malignancy risk in surgically treated patients with thyroid nodules classified as Bethesda Category III by comparing FNAC findings with histopathological outcomes. Materials and methods This observational retrospective study included patients with thyroid nodules classified as Bethesda Category III treated surgically at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC) Lahore between January 2014 and January 2024. Data were analyzed using SPSS version 20 (IBM Corp., Armonk, NY, US). Results A total of 44 patients were included in the study, with a mean age of 50.59 years. The majority were female 36 (81.8%) with 8 (18.2%) males. All patients underwent surgery, with 23 (52.3%) undergoing total thyroidectomy and 21 (47.7%) undergoing lobectomy. Final histopathological analysis revealed benign findings in 27 (61.4%) cases and malignancy in 17 (38.6%). Conclusion In our study, benign adenomatous nodules and papillary thyroid carcinoma had equal prevalence. The malignancy rate in Bethesda Category III nodules was 38.6%, higher than the previously reported range of 10% to 30%. This elevated risk may reflect the specialized cancer center setting in which the study was conducted, aligning with similar findings from other cancer centers. These results suggest that Bethesda Category III may carry a higher malignancy risk, warranting reconsideration of current management guidelines.