Surgical outcomes of Bethesda System for Reporting Thyroid Cytopathology diagnostic category class I, II, and III thyroid nodules
By
Sang-Wook Park
Ga Young Lee
Min Ji Kim
Minsu Kwon
Young Ho Jung
Seung-Ho Choi
Dong Eun Song
Yoon Se Lee
May 25, 2026
Clinical Scorecard: Surgical Results for Thyroid Nodules Classified as Bethesda System Categories I, II, and III
At a Glance
Category Detail
Condition Thyroid Nodules Key Mechanisms Evaluation of surgical outcomes and risk factors predictive of malignancy in Bethesda classes I–III. Target Population Patients with thyroid nodules classified as Bethesda classes I, II, or III who underwent thyroidectomy. Care Setting Retrospective review of surgical cases from 2010 to 2020.
Key Highlights
Carcinoma confirmed in 32.3% of patients with Bethesda classes I–III nodules. Malignancy rates: 23.5% (class I), 20.4% (class II), 49.4% (class III). Atypia with nuclear and architectural features (AUS-N/A) is an independent predictor of malignancy. Surgical intervention is recommended for class III nodules, especially with AUS-N/A. Low probability of recurrence and favorable prognosis post-surgery. Guideline-Based Recommendations
Diagnosis
Surgery is not routinely recommended for Bethesda classes I, II, or III unless specific criteria are met. Management
Consider surgical resection for large, growing tumors with compressive symptoms or clinical suspicion of malignancy. Monitoring & Follow-up
Utilize additional diagnostic tools like repeated FNA, CNB, and molecular testing to improve diagnostic accuracy. Risks
Higher malignancy risk in Bethesda class III nodules, particularly with AUS-N/A. Patient & Prescribing Data
Patients undergoing thyroidectomy for Bethesda classes I–III nodules.
Surgical outcomes indicate a significant rate of malignancy in class III nodules.
Clinical Best Practices
Integrate clinical findings with cytopathologic evaluation to reduce discrepancies. Consider molecular testing for indeterminate cytology to stratify malignancy risk. Related Resources & Content
