Related Experiment Video
Updated: Sep 13, 2025
A Swin Transformer-Based Model for Thyroid Nodule Detection in Ultrasound Images
Published on: April 21, 2023
Refining the Management of Bethesda III Thyroid Nodules by Combining Nuclear Atypia with Sonographic Suspicion
Hao Li1, Caroline C Y Lee1,2, Hau W Khoo3
1Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore.
Objective:
The risk of malignancy (ROM) in thyroid nodules with Bethesda III cytology ranges from 6% to 30%. Further stratification may aide the decision for diagnostic hemithyroidectomy.
Study Design:
Retrospective chart review.
Setting:
Tertiary general hospital.
Methods:
Bethesda III thyroid nodules consecutively resected between 2010 and 2016 are reviewed. Sonographic images are matched to the pathologic diagnoses and exported. Blinded to the diagnosis, 2 to 3 radiologists reached a consensus on the ACR-TIRADS, EU-TIRADS, and ATA classification of the nodules. A head and neck pathologist reviewed the cytology for nuclear atypia. Univariate and multivariate analyses are performed.
Results:
Out of a total of 243 nodules, 63 (26%) are malignant and 3 (1.2%) are NIFTP. Nuclear atypia, hypoechogenicity, intermediate and high-risk categories in ACR-TIRADS, EU-TIRADS, or ATA are significantly associated with malignancy (including NIFTP) in both univariate and multivariate analysis (P < .001-.028). The area-under-the-receiver-operator-curve of the diagnostic model incorporating sex, nuclear atypia, and sonographic suspicion is 0.714, 0.695, 0.711, and 0.699, respectively, when sonographic suspicion is defined as hypoechogenicity, TR4/5, EU-TIRADS intermediate/high-risk, or ATA moderate/high suspicion. In TR5, EU-TIRADS or ATA high-risk nodules or nodules with marked hypoechogenicity/punctate echogenic foci/irregular margins, nuclear atypia significantly increases the ROM from 6.3%-9.7% to 59.4%-75.0%. Majority of the cancers diagnosed by nuclear atypia and sonographic suspicion are papillary carcinomas.
Conclusion:
Diagnostic hemithyroidectomy is recommended in nodules with both AUS-nuclear atypia and high sonographic suspicion. Improved identification of follicular-patterned thyroid carcinomas is required to better manage the other Bethesda III nodules.
