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Are We Operating Smarter? Risk of Malignancy Across Bethesda Categories-A 10-Year Institutional Experience
Shawn Joseph Thadathil1, Karunya Gopal Rajagopal1, Iona Leekha Mathew2
1Department of Head and Neck Surgical Oncology, VPS Lakeshore Hospital and Research Centre, Kochi, India.
Head & Neck
|February 10, 2026
Summary
Thyroid cancer risk stratification using The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) showed higher malignancy rates in indeterminate categories (III-V) than estimated. This data aids clinical decisions, especially where molecular testing is unavailable.
Area of Science:
- Endocrinology
- Oncology
- Cytopathology
Background:
- Global thyroid cancer incidence is rising, linked to increased thyroid nodule detection.
- This rise raises concerns about overdiagnosis and overtreatment.
- The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) aids risk stratification, but indeterminate categories (III-V) pose challenges, especially without molecular testing.
Purpose of the Study:
- To assess the risk of malignancy (ROM) for each TBSRTC category in Indian patients undergoing thyroid surgery.
- To compare these ROM rates with the 2023 TBSRTC risk estimates.
Main Methods:
- Retrospective analysis of fine-needle aspiration cytology and histopathology data (2014-2024).
- Calculation of ROM for each TBSRTC category.
- Comparison of calculated ROM with established TBSRTC risk estimates.
Main Results:
- TBSRTC VI showed a 100% malignancy rate.
- Significantly higher malignancy rates were observed in TBSRTC III (58.7%), IV (82.7%), and V (100%) compared to TBSRTC estimates (22%, 30%, 74%).
- TBSRTC III nuclear (70.0%) had a higher malignancy rate than TBSRTC III other (40.57%).
Conclusions:
- Institution-specific malignancy data improves TBSRTC's clinical utility.
- Enhanced data aids patient counseling, particularly in resource-limited settings.
- Local data is crucial for accurate thyroid cancer risk assessment when molecular diagnostics are unavailable.
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