IS IT POSSIBLE TO PREDICT MALIGNANCY IN BETHESDA III AND IV THYROID NODULES?

AUTHORS:
S. Dughiero (PADOVA, Italy) , F. Torresan (PADOVA, Italy) , J.L. Carrillo Lizarazo (PADOVA, Italy) , S. Censi (PADOVA, Italy) , C. Mian (PADOVA, Italy) , M. Iacobone (PADOVA, Italy)
Background:
The risk of malignancy (ROM) in thyroid nodules with BETHESDA III and IV results at cytology may widely vary, ranging between 10 and 30%; thus, the management (follow up versus surgery) remains controversial. This study was aimed to assess the ROM in a large cohort of patients undergoing surgery in a tertiary academic centre for these undetermined nodules
Methods:
Thyroid surgery for BETHESDA III or IV nodules was performed in 534 patients. Anamnestic, surgical, pathological and biochemical data were evaluated.
Results:
Malignancy was found in 230 patients (43%). The ROM in BETHESDA III nodules was 33%; in BETHESDA IV nodules it was 56% (p<0.01). A younger age at the surgery (50.3 vs 53.5 years, OR 0.982; p=0.006) and a BETHESDA IV at cytology (OR 2.69; p<0,001) were predictive factors of malignancy. When focusing exclusively on BETHESDA III nodules, no significant predictive risk factors were found. In BETHESDA IV nodules, younger age (50 versus 55.4; OR 0.977; p=0.013) and size of the nodule larger than 3cm (OR 1.77; p=0.039) were significant predictive risk factors of malignancy
Conclusions:
BETHESDA III and IV have a ROM surprisingly higher than expected. The prediction of malignancy remains challenging, especially for BETHESDA III nodules. Larger BETHESDA IV nodules in younger patients have a significantly higher ROM and should be surgically treated