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Risk of malignancy in thyroid nodules Bethesda III sub classification into nuclear atypia and architectural atypia. A
Fahad Alwadi1, Mohammed Alessa1, Elaf Abdulkarim Alamer1
1From the Division of Otolaryngology-Head and Neck Surgery, Department of Surgery (Alwadi, Alessa, Alaraifi, Alsalem) and from the Department of Pathology and Laboratory Medicine (Pharaon, Alhabib), King Abdulaziz Medical City, Ministry of National Guard Health Affairs; from the Department of Otolaryngology-Head and Neck Surgery (Alessa) and from the College of Medicine (Alessa, Alrabiah), King Saud University; from the College of Medicine (Alamer), King Abdulaziz Medical City, Ministry of National Guard Health Affairs; and from the Department of Pathology and Laboratory Medicine King Abdulaziz Medical University for Health Sciences and Department of Pathology and Laboratory Medicine, King Abdullah International Medical Research Center (Pharaon), Riyadh, Kingdom of Saudi Arabia.
Objectives:
To identify the risk of malignancy in the Bethesda III category based on histopathological subclassification.
Methods:
We retrospectively analyzed 193 patients with Bethesda III thyroid nodules who underwent surgical resection. The primary outcome was the malignancy risk associated with each histopathological sub-classification.
Results:
Of 193 patients, final histopathology revealed malignant nodules in 96 (49.7%). The malignancy rates varied among the Bethesda III subcategories, with Hürthle cell atypia of undetermined significance demonstrating the highest rate (55.6%), followed by cytological atypia (55.4%), architectural atypia (50.6%), and combined cytological and architectural atypia (33.3%). However, no significant difference in malignancy rates was observed among the Bethesda III subcategories (p=0.240). Papillary thyroid carcinoma was the most common malignant tumor in all Bethesda III subcategories.
Conclusion:
Bethesda III nodules pose a clinical challenge. Our findings indicate a higher risk of malignancy in patients with cytologic atypia. Bethesda III subclassification may improve clinical decisions and interdisciplinary communication.
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