Ultrasound Risk Stratification and Bethesda Cytology for Predicting Malignancy in Thyroid Nodules: A...

Thyroid nodules are one of the most frequently seen endocrine conditions in clinical practice and a major challenge in diagnosis, as only a small proportion of them are malignant. The current study aimed to compare the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) ultrasonographic classification with the Bethesda cytological category in thyroid nodules with histopathological diagnosis.

Our study was conducted as a hospital-based cross-sectional observational analysis in the Departments of Pathology and Radiodiagnosis at Rajendra Institute of Medical Sciences (RIMS), Ranchi. A total of 50 consecutive patients fulfilling the eligibility criteria were included. Ultrasonographic examination was performed using ACR-TIRADS criteria, and fine needle aspiration cytology (FNAC) findings were interpreted according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Histopathological examination served as the reference standard.

In our study, the mean age was 33.76 ± 12.85 years, and females constituted 34 (68.0%) cases. TIRADS 3 nodules constituted the largest subgroup with 16 (32.0%) cases. Histopathological examination identified 29 (58.0%) benign lesions and 21 (42.0%) malignant lesions. Bethesda cytology demonstrated superior concordance with histopathology, with a specificity of 100% and excellent diagnostic accuracy with an area under the curve (AUC) of 0.81. In contrast, ACR-TIRADS showed poor discriminatory ability with an AUC of 0.51.

Bethesda cytology showed superior concordance and diagnostic accuracy compared with ultrasonographic ACR-TIRADS classification in predicting malignant thyroid nodules. Combined radiological and cytological evaluation may improve diagnostic certainty and support appropriate surgical decision-making.