Role of sonographic diagnosis in managing Bethesda class III nodules
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Published on: April 21, 2023
1Department of Radiology, Inje University College of Medicine, Busan, South Korea. dwultra@lycos.co.kr
Insights
Ultrasound (US) evaluation aids in managing thyroid nodules with Bethesda class III cytology, offering high diagnostic efficacy. This imaging technique helps determine malignancy risk in uncertain cases.
Area of Science:
- Radiology
- Endocrinology
- Oncology
Background:
- Bethesda class III cytology presents a diagnostic challenge for thyroid nodules.
- Ultrasound-Fine Needle Aspiration (US-FNA) limitations necessitate improved assessment methods.
Purpose of the Study:
- To evaluate the diagnostic effectiveness of ultrasound (US) in assessing thyroid nodules categorized as Bethesda class III.
- To determine the malignancy rate and diagnostic performance metrics for these nodules.
Main Methods:
- Prospective classification of 1289 thyroid nodules from 1036 patients using US features.
- Nodules were categorized into five diagnostic groups by a single radiologist.
- Diagnostic efficacy calculated by comparing US diagnoses with histopathology of Bethesda class III nodules.
Main Results:
- A malignancy rate of 46.5% was observed in Bethesda class III nodules.
- Ultrasound demonstrated high sensitivity (100%) and specificity (94.7%) when borderline cases were excluded.
- Diagnostic values remained significant regardless of borderline nodule reclassification.
Conclusions:
- Ultrasound diagnosis, using the current classification system, is valuable for managing Bethesda class III thyroid nodules.
- US can assist clinicians in making informed decisions regarding further patient management.
Background And Purpose:
Bethesda class III cytology is an important limitation of the US-FNA in assessing thyroid nodules. This study aimed to assess the diagnostic efficacy of US in evaluating thyroid nodules with Bethesda class III cytology.
Materials And Methods:
From January 2008 to December 2009, 1036 patients with 1289 thyroid nodules diagnosed by US and subsequent US-FNA biopsy were enrolled in the study. On the basis of US features, each thyroid nodule was prospectively classified by a single radiologist into 1 of 5 diagnostic categories: benign, probably benign, borderline, possibly malignant, and malignant. Solid nodules were classified by using all 5 categories, whereas partially cystic nodules were classified by using 4 (borderline was omitted). We calculated the diagnostic efficacy of thyroid US by comparing the US diagnoses with the histopathology results of Bethesda class III nodules.
Results:
Of the 51 Bethesda class III nodules, 35 were surgically confirmed and 8 were histologically diagnosed, and a malignancy rate of 46.5% (20/43) was determined. From the 43 nodules, the sensitivity, specificity, positive and negative predictive values, and accuracy were calculated with 9 borderline nodules excluded (100%, 94.7%, 93.3%, 100%, and 97.0%, respectively) and with the 9 when reclassified as benign (63.6%, 95.2%, 93.3%, 71.4%, and 79.1%, respectively) and malignant (100%, 85.7%, 88.0%, 100%, and 93.0%, respectively). The values obtained with exclusion and malignancy reclassification of 9 borderline nodules were not significantly different (P = .250).
Conclusions:
US diagnosis by using the present US classification system can be helpful for managing Bethesda class III nodules.
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