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Background <p>Bethesda category III thyroid nodules pose substantial management challenges, and a validated malignancy risk stratification system is urgently needed to guide clinical decision-making. This study aims to identify specific sonographic and cytological features associated with malignant Bethesda III thyroid nodules and to develop a practical model for predicting malignancy risk through an integrated analysis of multimodal data from histopathologically confirmed cases.</p> Methods <p>This retrospective study used clinical data from patients with both Bethesda III cytological diagnoses and corresponding surgical pathology outcomes between July 2016 and December 2024. The sonographic, clinical, and cytological characteristics of benign and malignant nodules were systematically assessed and compared. Univariable and multivariable logistic regression analyses were conducted to evaluate the association between these features and malignancy. A prediction nomogram, incorporating sonographic and cytological features independently associated with malignancy, was developed and validated to assess its performance.</p> Results <p>In this study, a total of 187 Bethesda III thyroid nodules were analyzed, consisting of 77 benign nodules and 110 malignant nodules. Factors such as maximum diameter ≤ 1&#xa0;cm, absence of smooth margins, microcalcifications, and nuclear atypia in cytology were identified as independent factors associated with malignancy. A prediction nomogram model was developed using these variables, demonstrating strong performance in distinguishing between benign and malignant nodules categorized as Bethesda III, with an area under the curve (AUC) of 0.874.</p> Conclusions <p>In Bethesda III thyroid nodules, malignant cases were associated with suspicious sonographic characteristics, smaller size (≤ 1&#xa0;cm), and cytological nuclear atypia. The nomogram developed from these predictors demonstrates potential utility in estimating malignancy risk for Bethesda III thyroid nodules.</p>

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Development of a malignancy risk prediction model combining ultrasound and cytology for Bethesda category III thyroid nodules

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月18日

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  • Fan Zhang,
  • Fang Mei,
  • Wen Chen

摘要

Background

Bethesda category III thyroid nodules pose substantial management challenges, and a validated malignancy risk stratification system is urgently needed to guide clinical decision-making. This study aims to identify specific sonographic and cytological features associated with malignant Bethesda III thyroid nodules and to develop a practical model for predicting malignancy risk through an integrated analysis of multimodal data from histopathologically confirmed cases.

Methods

This retrospective study used clinical data from patients with both Bethesda III cytological diagnoses and corresponding surgical pathology outcomes between July 2016 and December 2024. The sonographic, clinical, and cytological characteristics of benign and malignant nodules were systematically assessed and compared. Univariable and multivariable logistic regression analyses were conducted to evaluate the association between these features and malignancy. A prediction nomogram, incorporating sonographic and cytological features independently associated with malignancy, was developed and validated to assess its performance.

Results

In this study, a total of 187 Bethesda III thyroid nodules were analyzed, consisting of 77 benign nodules and 110 malignant nodules. Factors such as maximum diameter ≤ 1 cm, absence of smooth margins, microcalcifications, and nuclear atypia in cytology were identified as independent factors associated with malignancy. A prediction nomogram model was developed using these variables, demonstrating strong performance in distinguishing between benign and malignant nodules categorized as Bethesda III, with an area under the curve (AUC) of 0.874.

Conclusions

In Bethesda III thyroid nodules, malignant cases were associated with suspicious sonographic characteristics, smaller size (≤ 1 cm), and cytological nuclear atypia. The nomogram developed from these predictors demonstrates potential utility in estimating malignancy risk for Bethesda III thyroid nodules.