Torres-Cuenca Dayana, Ortiz Juan Eduardo, González-Andrade Fabricio
Escuela de Especialidades Médicas, Colegio de Ciencias de la Salud CoCSa' Universidad San Francisco de Quito USFQ, Diego de Robles Street S/N and Pampite, 170901, Quito, Ecuador.
Hospital Padre Carollo "Un canto para la vida", Av. Rumichaca S33-10, 170146, Quito, Ecuador.
Clin Transl Oncol. 2025 Aug 21. doi: 10.1007/s12094-025-04034-5.
Thyroid nodules categorized as TIRADS 3 are typically considered low risk for malignancy (estimated < 5%) under the 2017 ACR TI-RADS guidelines. However, the real-world application of these criteria may vary, with many TIRADS 3 nodules undergoing fine-needle aspiration (FNA) despite recommendations for surveillance. This study aimed to identify clinical and ultrasonographic predictors of malignancy in TIRADS 3 nodules to enhance risk stratification.
This retrospective, single-center study included 200 patients aged 18-65 years with ultrasound-confirmed TIRADS 3 thyroid nodules who underwent FNA between January 2021 and December 2022. Although ACR guidelines recommend biopsy for nodules ≥ 2.5 cm, FNA was also performed in smaller nodules presenting with high-risk features such as capsule bulging or central-peripheral vascularity. Data were collected from anonymized hospital records. Multivariate logistic regression was used to identify independent predictors of malignancy.
The malignancy rate was 20%, exceeding the expected threshold for TIRADS 3 nodules. Capsule expansion (OR 18.50, p < 0.001), central-peripheral vascularity (OR 4.99, p = 0.004), and a family history of thyroid cancer (OR 13.08, p = 0.001) were identified as significant predictors. All malignancy diagnoses were based on cytological findings (Bethesda V/VI), with no histopathologic confirmation available.
Certain TIRADS 3 nodules may possess a higher malignancy risk than traditionally assumed. Incorporating additional ultrasound features and clinical context may improve diagnostic accuracy. Future prospective studies with histopathological confirmation are warranted to validate these predictors.
根据2017年美国放射学会（ACR）甲状腺影像报告和数据系统（TI-RADS）指南，分类为TI-RADS 3的甲状腺结节通常被认为恶性风险较低（估计<5%）。然而，这些标准在实际应用中可能存在差异，尽管指南建议进行监测，但许多TI-RADS 3结节仍接受了细针穿刺活检（FNA）。本研究旨在确定TI-RADS 3结节恶性的临床和超声预测因素，以加强风险分层。
这项回顾性单中心研究纳入了200例年龄在18至65岁之间、经超声确诊为TI-RADS 3甲状腺结节且在2021年1月至2022年12月期间接受FNA的患者。尽管ACR指南建议对直径≥2.5 cm的结节进行活检，但对于具有包膜膨出或中央-周边血管等高危特征的较小结节也进行了FNA。数据从匿名的医院记录中收集。采用多因素逻辑回归分析确定恶性的独立预测因素。
恶性率为20%，超过了TI-RADS 3结节的预期阈值。包膜扩张（比值比[OR]18.50，p<0.001）、中央-周边血管（OR 4.99，p=0.004）和甲状腺癌家族史（OR 13.08，p=0.001）被确定为显著预测因素。所有恶性诊断均基于细胞学检查结果（贝塞斯达Ⅴ/Ⅵ类），无组织病理学确诊。
某些TI-RADS 3结节的恶性风险可能比传统认为的更高。纳入更多超声特征和临床背景可能提高诊断准确性。未来有必要进行有组织病理学确诊的前瞻性研究以验证这些预测因素。
