Clinical Report: Development of a Preoperative Malignancy Risk Assessment for Bethesda III Thyroid Nodules
Overview
This study developed a preoperative risk score for malignancy in Bethesda III thyroid nodules based on a multicenter cohort. The score incorporates three independent predictors.
Background
Bethesda III thyroid nodules present a significant clinical challenge due to their estimated malignancy risk of 13–30%. Accurate risk assessment is crucial to avoid unnecessary surgeries while ensuring that malignant cases are appropriately managed. This study seeks to enhance preoperative evaluation by developing a straightforward risk score using routinely available clinical variables.
Data Highlights
Variable
Association with Malignancy
Moderate-to-high ultrasound risk
Independent predictor
Nuclear atypia on fine-needle aspiration
Independent predictor
Lymphocytic thyroiditis on fine-needle aspiration
Independent predictor
Malignancy rate
23.5%
Score range
0 to 15 points
Best diagnostic performance cut-off
10 points or higher
Key Findings
The malignancy rate in the study cohort was 23.5%.
Three independent predictors of malignancy were identified: ultrasound risk, nuclear atypia, and lymphocytic thyroiditis.
A risk score ranging from 0 to 15 points was developed based on these predictors.
A cut-off score of 10 points or higher was identified.
The predicted probability of malignancy varied from 2.4% to 74.8% across the score spectrum.
Clinical Implications
External validation in larger cohorts is necessary before clinical implementation.
Conclusion
This study presents a preoperative risk assessment tool for Bethesda III thyroid nodules.
by Manuel Carpio-Salmerón, Mariano Tébar-Caballero, Pau Benito, Clemente García-Hidalgo, Georgios Kyriakos, Antonio Ríos-Vergara, Ginés Luengo-Gil, Carlos Carazo-Casas, Ana Casas-Miras, Luis Marín-Martínez, Ana Belén Arroyo
