Li Hao, Lee Caroline C Y, Khoo Hau W, Bundele Manish M, Gan Jereme Y J, Fu Ernest W Z, Lim Ming Y, Goh Julian P N, Soon Alvin Y Q
Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore.
Department of Otolaryngology, Head and Neck Surgery, Khoo Teck Puat Hospital, Singapore, Singapore.
Otolaryngol Head Neck Surg. 2025 Jul 29. doi: 10.1002/ohn.1360.
The risk of malignancy (ROM) in thyroid nodules with Bethesda III cytology ranges from 6% to 30%. Further stratification may aide the decision for diagnostic hemithyroidectomy.
Retrospective chart review.
Tertiary general hospital.
Bethesda III thyroid nodules consecutively resected between 2010 and 2016 are reviewed. Sonographic images are matched to the pathologic diagnoses and exported. Blinded to the diagnosis, 2 to 3 radiologists reached a consensus on the ACR-TIRADS, EU-TIRADS, and ATA classification of the nodules. A head and neck pathologist reviewed the cytology for nuclear atypia. Univariate and multivariate analyses are performed.
Out of a total of 243 nodules, 63 (26%) are malignant and 3 (1.2%) are NIFTP. Nuclear atypia, hypoechogenicity, intermediate and high-risk categories in ACR-TIRADS, EU-TIRADS, or ATA are significantly associated with malignancy (including NIFTP) in both univariate and multivariate analysis (P < .001-.028). The area-under-the-receiver-operator-curve of the diagnostic model incorporating sex, nuclear atypia, and sonographic suspicion is 0.714, 0.695, 0.711, and 0.699, respectively, when sonographic suspicion is defined as hypoechogenicity, TR4/5, EU-TIRADS intermediate/high-risk, or ATA moderate/high suspicion. In TR5, EU-TIRADS or ATA high-risk nodules or nodules with marked hypoechogenicity/punctate echogenic foci/irregular margins, nuclear atypia significantly increases the ROM from 6.3%-9.7% to 59.4%-75.0%. Majority of the cancers diagnosed by nuclear atypia and sonographic suspicion are papillary carcinomas.
Diagnostic hemithyroidectomy is recommended in nodules with both AUS-nuclear atypia and high sonographic suspicion. Improved identification of follicular-patterned thyroid carcinomas is required to better manage the other Bethesda III nodules.
贝塞斯达Ⅲ类甲状腺结节的恶性风险（ROM）在6%至30%之间。进一步分层可能有助于决定是否进行诊断性半甲状腺切除术。
回顾性病历审查。
三级综合医院。
回顾2010年至2016年间连续切除的贝塞斯达Ⅲ类甲状腺结节。将超声图像与病理诊断结果匹配并导出。在不知诊断结果的情况下，2至3名放射科医生就结节的美国放射学会-甲状腺影像报告和数据系统（ACR-TIRADS）、欧洲甲状腺影像报告和数据系统（EU-TIRADS）以及美国甲状腺协会（ATA）分类达成共识。一名头颈病理学家对细胞学检查进行核异型性评估。进行单因素和多因素分析。
在总共243个结节中，63个（26%）为恶性，3个（1.2%）为非侵袭性滤泡性甲状腺肿瘤（NIFTP）。在单因素和多因素分析中，核异型性、低回声、ACR-TIRADS、EU-TIRADS或ATA中的中高风险类别均与恶性（包括NIFTP）显著相关（P < 0.001 - 0.028）。当将超声怀疑定义为低回声、TR4/5（ACR-TIRADS分类）、EU-TIRADS中/高风险或ATA中度/高度怀疑时，纳入性别、核异型性和超声怀疑的诊断模型的受试者操作特征曲线下面积分别为0.714、0.695、0.711和0.699。在TR5（ACR-TIRADS分类）、EU-TIRADS或ATA高风险结节或具有明显低回声/点状强回声灶/边缘不规则的结节中，核异型性显著将ROM从6.3% - 9.7%提高到59.4% - 75.0%。通过核异型性和超声怀疑诊断出的大多数癌症为乳头状癌。
对于同时具有不典型细胞核（AUS）-核异型性和高超声怀疑的结节，建议进行诊断性半甲状腺切除术。需要改进对滤泡型甲状腺癌的识别，以更好地处理其他贝塞斯达Ⅲ类结节。
