scholarly journals OR28-05 Approaching Indeterminate Thyroid Nodules in the Absence of Molecular Markers. “The BETH-TR Score”

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Subramanian Kannan ◽  
Kranti Khadilkar ◽  
Shivaprasad Kumbenahalli Siddegowda
Keyword(s):  
Molecular Markers ◽  
Thyroid Nodules ◽  
High Volume ◽  
Easy Access ◽  
P Value ◽  
Papillary Thyroid ◽  
Thyroid Cancers ◽  
The Mean ◽  
Roc Area ◽  
Benign Nodules

Abstract Context: Given the lack of easy access to molecular markers, for indeterminate thyroid nodules (Bethesda (BETH) category III, IV), the clinician can either decide to get a second opinion from an expert high volume thyroid cytopatholgist, re-do the FNAC after a period of 3-6 months or send the patient for a diagnostic hemithyroidectomy. Reviewing the sonographic risk features is also one way of triaging these nodules. The ACR-TIRADS (TR) is an objective method of sonographic risk assessment and is superior to other forms of sonographic classification. Aim: We propose combining the scoring of TR category and BETH category (both expressed as numerical value and summated) and look at the score which could potentially guide the clinician in deciding whom to send for surgery. Settings and Design: Observational Prospective collection of consecutive patient data from Thyroid FNAC clinic. Statistical analysis used: The BETH categories were represented numerically and summated with the TR category. The categorical outcome variables of Benign and Malignant nodules and the summated score was analysed using Kruskal-Wallis test. Results: We analysed 450 FNAC data, out of which 403 were thyroid nodule aspirates. Out of these nodules, 96 of them underwent surgery and 64% of these nodules were malignant on final histopathology (Malignant=62 and Benign=34). The mean (sd) size of the benign nodules was 3.6 (2.2)cm compared to 2.8 (1.8)cm of the malignant nodules. After excluding those with BETH 1 (n=4), the mean BETH-TR score for benign nodules was 6(1.4) and malignant nodules 9.4(2.1) (p<0.0001). The BETH-TR score progressively increased from 7.3(0.92) in Follicular thyroid cancers (FTC) to 8.6(1.4) in Follicular variant Papillary thyroid cancer (FVPTC) to 10(1.3) in classic Papillary thyroid cancers (PTC). Among the indeterminate nodules (BETH III & IV; n=40), the BETH-TR score of benign nodules was 6.75(1) and malignant nodules was 7.5(0.72) (p value=0.01). A BETH-TR score >=7 gave a sensitivity of 92% specificity of 74% and correctly identified malignant nodules in 86% of cases (Likelihood ratio 3.5; ROC area: 0.8841; CI 0.79-0.94). Conclusion: A combined sono-cytological BETH-TR score is one way to triage management of indeterminate thyroid nodules. A BETH-TR score >=7 gave a sensitivity of 92% specificity of 74% and correctly identified malignant nodules in 86% of cases.

scholarly journals Hashimoto Thyroiditis and Thyroid Ultrasound: A Prospective Study

2021 ◽  
Author(s):  
Anabela Zunino ◽  
Claudia Vazquez ◽  
Laura Delfino ◽  
Adriana Reyes ◽  
Alicia Lowenstein
Keyword(s):  
Prospective Study ◽  
Thyroid Nodules ◽  
Thyroid Volume ◽  
Hashimoto Thyroiditis ◽  
Needle Aspiration ◽  
Thyroid Peroxidase ◽  
Papillary Thyroid ◽  
Immunological Activity ◽  
Benign Nodules ◽  
A Prospective Study

Abstract Purpose We performed a prospective study in patients with positive thyroid peroxidase antibodies (TPOAb), to describe their ultrasound (US) patterns and the prevalence of thyroid nodules. Methods In 195 consecutive patients, with positive TPOAb, thyroid US was performed by the same physician and equipment and categorized into four echographic patterns (EP). We determined the prevalence of thyroid nodules and their etiology confirmed by cytology or histology. Results The median TPOAb was 526 IUI/ml. EP1 or normal US was present in 9,7%; EP2 or early/indeterminate stage in 29,4%; EP3 or established thyroiditis in 45,4% and EP4 or advanced/late stage in 15,5% of the patients. TPOAb (median = 857 UI / ml) (p = 0.001), TSH and thyroid volume ​​were higher in EP3. A higher degree of fibrosis was associated with TPOAb > 1000 IU/ml(p = 0,003). Thyroid nodules were reported on US at 47,2% of HT. Fine needle aspiration(FNA) was performed in 49/60 nodules. Cytology: BII: 41 patients (83,7%), B V: 1 patient (2%): suspicious for lymphoma; B VI: 3 patients(6,1%) : Papillary thyroid carcinoma. Benign cytology was present in 56% of EP3 (p = 0,048). Conclusions Higher TPOAb, TSH levels, and thyroid volume were associated with EP3. Fibrosis correlated with TPOAb > 1000 IU/ml. In our population, benign nodules were associated with established thyroiditis patterns. The increased inflammation and immunological activity of Hashimoto thyroiditis (HT) could be a favorable environment for growth factors for benign nodular development.

scholarly journals Neutrophils to lymphocytes ratio between benign and malignant thyroid nodule

2021 ◽  
Vol 37 (7) ◽  
Author(s):  
Nazia Haider ◽  
Zahid Mahmood ◽  
Fizzah Khalid ◽  
Saad Abdul Razzak
Keyword(s):  
Thyroid Nodule ◽  
Lymphocyte Count ◽  
Complete Blood Count ◽  
P Value ◽  
Cross Sectional ◽  
Creative Commons ◽  
The Mean ◽  
Benign Nodules ◽  
Relationship Of ◽  
The Relationship

Objectives: To determine the relationship of Neutrophils to lymphocytes ratio (NLR) values with the benign and malignant thyroid nodules. Methods: In this cross-sectional clinical study conducted from September 1st 2020 to February 28th 2021, we included 216 patients who underwent thyroidectomy at Jinnah Postgraduate Medical Centre Karachi Pakistan. After thyroidectomy specimens were sent for pathologic examination. Patients were divided into two categories based on histopathologic results; Malignant nodule and benign nodules. Data of complete blood count was obtained from the pre-operative lab investigations and NLR was calculated. Results: There were 42 (26%) men, and 116 (74%) women of 158 in the BTN group, 18 (31%) men, and 40 (69%) women of 58 in the MTN group. The mean age of 48±6 years in the BTN group as well as 47 ±8 years in the MTN group (p-value 0.32). The mean neutrophil count in the BTN group was 4.26±2.8 versus 4.41±2.2 (x 1000/mm3) the malignance thyroid group (p-value = 0.71). The mean lymphocyte count was 3.81±0.9 (x 1000/mm3) in the BTN group and 3.61±1.2 (x 1000/mm3) in the malignance group (p-value = 0.18). The mean NLR value for the benign thyroid nodular group was 1.19±2.2 and 1.22±1.8 in the malignant thyroid nodular group (p-value = 0.92). Conclusion: According to the results of this study, we concluded that preoperative period biochemistry laboratory results such as neutrophils count, lymphocyte count, and NLR value don’t provide enough evidence to differentiate between benign and malignant thyroid carcinoma. doi: https://doi.org/10.12669/pjms.37.7.4503 How to cite this:Haider N, Mahmood Z, Khalid F, Razzak SA. Neutrophils to lymphocytes ratio between benign and malignant thyroid nodule. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4503 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Somatic genetic alterations in a large cohort of pediatric thyroid nodules

2019 ◽  
Vol 8 (6) ◽  
pp. 796-805 ◽  
Author(s):  
Barbora Pekova ◽  
Sarka Dvorakova ◽  
Vlasta Sykorova ◽  
Gabriela Vacinova ◽  
Eliska Vaclavikova ◽  
...  
Keyword(s):  
High Frequency ◽  
Detection Rate ◽  
Thyroid Nodules ◽  
Pediatric Patients ◽  
Distant Metastases ◽  
Genetic Alterations ◽  
Papillary Thyroid ◽  
Benign Lesions ◽  
Benign Nodules ◽  
Generation Sequencing

There is a rise in the incidence of thyroid nodules in pediatric patients. Most of them are benign tissues, but part of them can cause papillary thyroid cancer (PTC). The aim of this study was to detect the mutations in commonly investigated genes as well as in novel PTC-causing genes in thyroid nodules and to correlate the found mutations with clinical and pathological data. The cohort of 113 pediatric samples consisted of 30 benign lesions and 83 PTCs. DNA from samples was used for next-generation sequencing to identify mutations in the following genes: HRAS, KRAS, NRAS, BRAF, IDH1, CHEK2, PPM1D, EIF1AX, EZH1 and for capillary sequencing in case of the TERT promoter. RNA was used for real-time PCR to detect RET/PTC1 and RET/PTC3 rearrangements. Total detection rate of mutations was 5/30 in benign tissues and 35/83 in PTCs. Mutations in RAS genes (HRAS G13R, KRAS G12D, KRAS Q61R, NRAS Q61R) were detected in benign lesions and HRAS Q61R and NRAS Q61K mutations in PTCs. The RET/PTC rearrangement was identified in 18/83 of PTCs and was significantly associated with higher frequency of local and distant metastases. The BRAF V600E mutation was identified in 15/83 of PTCs and significantly correlated with higher age of patients and classical variant of PTC. Germline variants in the genes IDH1, CHEK2 and PPM1D were found. In conclusion, RET/PTC rearrangements and BRAF mutations were associated with different clinical and histopathological features of pediatric PTC. RAS mutations were detected with high frequency in patients with benign nodules; thus, our results suggest that these patients should be followed up intensively.

ARFI ELASTOGRAPHY IN THE DIAGNOSIS OF THYROID NODULES

2018 ◽  
Vol 8 (5) ◽  
pp. 85-90
Author(s):  
Hanh Dau Thi My ◽  
Quan Nguyen Phuoc Bao ◽  
Thao Nguyen Thanh
Keyword(s):  
Strain Distribution ◽  
Thyroid Nodules ◽  
Radiation Force ◽  
Acoustic Radiation Force Impulse ◽  
Tissue Imaging ◽  
Tissue Elasticity ◽  
Arfi Elastography ◽  
2D Ultrasound ◽  
The Mean ◽  
Benign Nodules

Objective: To describe the sonography characteritics of the thyroid nodules using Acoutic Radiation Force Impulse Imaging (ARFI), and to evaluate the role of ARFI technique combination with 2D Ultrasound in diagnosing thyroid nodules. Methods: 2D Ultrasound and ARFI Elatography were caried out in 63 patients who have thyroid nodules. Images of 2D Ultrasound were classified according to Russ G. (French TIRADS). ARFI Elastography was performed by 2 techniques: “ Virtual Touch tissue imaging” in order to image of strain distribution and “Virtual Touch tissue quantification Imaging” to measure the shear wave velocity (SWV) in the tissue. Strain distribution was classified according to Xu’s VTI grading method. SWV was measured in the solid portions or suspicious regions of a nodule, avoiding cystic portions or calcifications. According to the results of pathology, we determine and compare the value between 2D Ultrasound plus ARFI elastography and 2D Ultrasound alone. Results: 63 patients with thyroid nodules: 14 malignant nodules and 49 benign nodules. The mean SWV of benign nodules were 1.78±1.22 m/s, the mean SWV of malignant nodules were 7.09±2.87 m/s. The best cut-off point for SWV was 2.4 m/s. For VTI, grade IV was the best cut-off value in differentiation of benign and malignant thyroid nodules. 2D Ultrasound plus VTI and 2D Ultrasound plus VTQ: Se 100% and 100%, Sp 87.8% and 85.7%, PPV 70% and 66.7%, NPV 100% and 100%, Acc 90.5 % and 88.9% (K=0.761 and K=0.727). Conclusions: In addition to the morphologic characteristics of thyroid nodules, ARFI provides information about lesion’s tissue elasticity, which can be useful tool in diferential diagnosis of thyroid nodules. Key words: Acoustic Radiation Force Impulse Imaging (ARFI), thyroid nodules

Interobserver Agreement of Planar and SPECT Tc99m-MIBI Scintigraphy for the Assessment of Hypofunctioning Thyroid Nodules

2019 ◽  
Vol 58 (03) ◽  
pp. 258-264
Author(s):  
Simone Schenke ◽  
Rigobert Klett ◽  
Peter Acker ◽  
Thomas Rink ◽  
Michael C Kreissl ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Interobserver Agreement ◽  
Thyroid Nodules ◽  
Study Cohort ◽  
Papillary Thyroid ◽  
Planar Images ◽  
Benign Nodules ◽  
Different Levels ◽  
Mibi Scintigraphy ◽  
Spect Images

Abstract Introduction Thyroid scintigraphy with 99mTc-methoxyisobutylisonitrile (MIBI) is a helpful tool for the risk stratification of thyroid nodules (TN). Whereas a nodule with low or hypointense MIBI uptake has a low risk for malignancy, a hyperintense uptake may indicate a malignant nodule, which requires surgical resection. The appropriate diagnostic or therapeutic regimen of an isointense nodule with an uptake similar to the paranodular tissue is discussed controversially. Aim of this study was to assess the interobserver agreement (IA) for the assignment of TN to the three categories: hypo-, iso-or hyperintense. Methods Retrospective analysis of planar and SPECT images of MIBI scintigraphy was performed in 36 randomly selected patients with hypofunctioning TN and histological diagnosis. Four observers with different levels of experience in MIBI-scintigraphy analyzed MIBI uptake and assigned the nodules to the appropriate category. To assess the IA, Fleiss‘ Kappa was calculated. Results The study cohort included 11 patients with papillary thyroid carcinoma (diameter 20.3 mm) and 25 patients with benign nodules (diameter 24.8 mm). The IA for all nodules using planar images was 0.76 compared to 0.80 for SPECT images. The IA was better in the subgroup of malignant nodules for planar images as well as SPECT images (Kappa 0.91 and 0.90, respectively) compared to benign nodules (0.65 and 0.76, respectively). Using SPECT images, only one thyroid carcinoma presented with hypointense uptake, the remainder with hyper- or isointense uptake. In contrast, benign nodules were found in all categories. Conclusion MIBI scintigraphy shows a good IA for the interpretation of thyroid carcinoma. The IA is further improved if MIBI scintigraphy is performed in SPECT technique.

Genetic copy number alterations and IL-13 expression differences in papillary thyroid cancers and benign nodules

Endocrine ◽  
2009 ◽  
Vol 36 (1) ◽  
pp. 155-160 ◽  
Author(s):  
ZeFei Zhao ◽  
Qing Wei ◽  
YongJu Zhao ◽  
Fukang Sun ◽  
Xiaolong Jin ◽  
...  
Keyword(s):  
Copy Number ◽  
Papillary Thyroid ◽  
Copy Number Alterations ◽  
Thyroid Cancers ◽  
Benign Nodules

scholarly journals SUN-LB83 Outpatient Radiofrequency Ablation Is a Safe and Effective Treatment Option for Benign Thyroid Nodules in North America

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jules Aljammal ◽  
Shahzad Ahmad ◽  
Iram Hussain
Keyword(s):  
Radiofrequency Ablation ◽  
Thyroid Nodules ◽  
Hormone Replacement ◽  
P Value ◽  
Free T4 ◽  
Thyroid Hormone Replacement ◽  
The Mean ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Abstract Background: Radiofrequency ablation (RFA) of thyroid nodules is a non-mainstream treatment option for benign thyroid nodules. Studies in Asia and Europe (1) have demonstrated RFA to be an effective outpatient alternative to surgery, however, these results have not been reproduced in North America. Hypothesis: RFA of symptomatic benign thyroid nodules can reduce morbidity associated with thyroidectomies, without sacrificing favorable clinical outcomes. Methodology: A retrospective review of 11 patients (all female and Caucasian) with 13 thyroid nodules treated with RFA in our practice was conducted (Nov 2018 - Oct 2019). The 9 nontoxic nodules were biopsied twice, and 4 toxic adenomas were biopsied once; all had benign cytopathology results prior to RFA. RFA was done under local anesthesia/conscious sedation, with follow-up telephone call after 2 days to assess complications (pain, voice change, hematoma/swelling, skin burns). Nodule volume in mL (length x depth x width in cm x 0.525), cosmetic score (2), and thyroid function tests (TSH and free T4) were recorded pre-procedure, and 6 - 10 weeks post procedure. The volume reduction rate (VRR) was calculated as follows: [(baseline volume - final volume)/baseline volume] x 100 (%). Results: The mean age of the patients was 45 years; 7 were euthyroid (not on thyroid hormone replacement), and 4 had hyperthyroidism. The mean volume of treated thyroid nodules decreased from 12.3 cc to 5.6 cc, with a mean VRR of ~ 54%. Thyroid nodules with volumes less than 10 cc (smaller) had a VRR of ~ 75%, whereas nodules with volumes more than 10 cc (larger) had a VRR of ~ 50%. The VRR between smaller and larger nodules (p-value: 0.11), and toxic adenomas and nontoxic thyroid nodules (p-value: 0.26), was not significantly different. 3 out of 4 patients with toxic adenomas normalized their TSH levels; 1 patient normalized free T4 levels, but TSH remained suppressed. None of the patients developed hypothyroidism. The cosmetic scores (indicating visible or palpable mass) improved by 50%. All patients had complete resolution of compressive symptoms. Minimal discomfort only reported at time of procedure. No complications were reported at the 2-day, or the 6-10-week follow-up. Conclusions: Outpatient RFA is a safe and effective treatment for benign thyroid nodules and toxic adenomas. There were no complications in our study, however, this may be limited by the small sample size and relatively short follow-up duration. Advantages of RFA include avoiding lifelong thyroid hormone replacement and complications of surgery and/or general anesthesia. We propose that RFA be considered as a first-line therapy for the treatment of benign thyroid nodules for these reasons. References: (1) Feldkamp, et al. Exp Clin Endocrinol Diabetes. 2020 Jan 7. doi: 10.1055/a-1075-2025. (2) Dobnig, et al. Thyroid. 2018 Apr;28(4):472-480. doi: 10.1089/thy.2017.0547.

scholarly journals MON-504 VEGFA and VEGFR2 Expression in Different Histological Types of Thyroid Nodules: Could Immunohistochemistry Have a Clinical Utility?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Natassia Elena Bufalo ◽  
Karina Colombera Peres ◽  
Larissa Teodoro ◽  
Paulo Latufi-Filho ◽  
Icleia Siqueira Barreto ◽  
...  
Keyword(s):  
Protein Expression ◽  
Clinical Utility ◽  
Thyroid Nodules ◽  
Vascular Endothelial ◽  
Papillary Thyroid ◽  
Thyroid Carcinomas ◽  
Tall Cell ◽  
Benign Nodules ◽  
Endothelial Growth Factors ◽  
Current Guidelines

Abstract Vascular endothelial growth factors (VEGFs) are a family of proteins involved in several elements that play an important role in the development of blood vessels. Besides acting in angiogenesis, VEGFA has important roles in chemotaxis, for macrophages and granulocytes, and vasodilation. VEGFA binds to VEGFR2, that acts on the MAPK and PI3K pathways, fundamental pathways for thyroid carcinogenesis. In order to assess the expression of VEGFA and VEGFR2, in different thyroid nodules, we used a Tissue MicroArray including 91 benign (74 females, 16 males, 49.84±12.65years old) and 125 malignant thyroid nodules (97 females, 28 males, 46.57±14.87 years old). Clinical and pathology data were obtained from 47 goiters; 43 follicular adenomas (FA) and a total of 104 papillary thyroid carcinomas (PTC), including 35 classic papillary thyroid carcinomas (CPTC), 30 follicular variant of PTC (FVPTC), 25 oxifilic variant of PTC (OVPTC), 14 tall cell papillary thyroid carcinomas (TCPTC); and 21 follicular thyroid carcinomas (FTC). All patients were managed according to a standard protocol based on current guidelines and followed-up for 116.9±70.8 months. VEGFA protein expression did not differentiate benign from malignant thyroid nodules. However, VEGFA was more frequently expressed in the less differentiated thyroid tissues. In fact, 95.8% of the FTC had positive expression. On the contrary, the intensity of this protein expression was progressively lower according to the process of cellular dedifferentiation (Goiter: 21.4%; FA: 16.3%; PTC: 8.7% and FTC: 0.0%; x2 = 0.031). There was no difference in VEGFR2 expression between malignant and benign nodules (x2= 0.108), but this protein showed more intense expression in tissues that also presented Hürthle cells (x2 <0.0001). We were not able to find any correlation, neither of VEGFA nor with VEGFR2 expression, and any other feature of aggressiveness, including invasion, metastasis, lymph node metastasis, and distant metastasis. We conclude that VEGFA and VEGFR2 expression may help identify less differentiated tumors and the analysis of a larger cohort may prove the clinical utility of these markers.

scholarly journals Thyroid nodules: ultrasonographic stratification of malignant risk by TIRADS

2018 ◽  
Vol 4 (5) ◽  
pp. 1188
Author(s):  
George Thomas ◽  
Surumi S. ◽  
Anulekha Mary John
Keyword(s):  
Statistical Analysis ◽  
Thyroid Nodules ◽  
Imaging Modality ◽  
Papillary Thyroid ◽  
Thyroid Cancers ◽  
Radiological Features ◽  
Thyroid Neoplasia ◽  
Noninvasive Imaging Modality ◽  
Thyroid Swelling ◽  
Ultrasound Features

<p class="abstract"><strong>Background:</strong> Thyroid neoplasia is easily diagnosed with, noninvasive imaging modality like ultrasonography that is widely available. TIRADS scoring is a useful modality in establishing better stratification of cancer risk in thyroid nodules, particularly, papillary thyroid cancers (PTC) as well as papillary thyroid microcancers (PTMC).</p><p class="abstract"><strong>Methods:</strong> All patients who presented with thyroid swelling and underwent surgery in the department of ENT were included in this study. All patients were evaluated with ultrasonographic examination of the neck. The decision of surgery was based on TIRADS scoring, size of swelling, or patient preference. Ultrasound features of the nodules, number of malignant features and TIRADS scoring were compared with final histopathology of the tumors.  </p><p class="abstract"><strong>Results:</strong> A total of 58 thyroid surgeries were performed from January 2014 to December 2017. On statistical analysis, we found that more the number of radiological features favouring malignancy more were the likelihood of finding malignant histopathology.</p><p class="abstract"><strong>Conclusions:</strong> Ultrasonographic features of malignancy along with TIRADS scoring are an extremely useful tool in diagnosing thyroid cancers and will help in standardising all sonographic reports.</p>

scholarly journals Are Bethesda III Thyroid Nodules More Aggressive than Bethesda IV Thyroid Nodules When Found to Be Malignant?

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2563
Author(s):  
Sena Turkdogan ◽  
Marc Pusztaszeri ◽  
Veronique-Isabelle Forest ◽  
Michael P. Hier ◽  
Richard J. Payne
Keyword(s):  
Thyroid Cancer ◽  
Papillary Thyroid Cancer ◽  
Thyroid Nodules ◽  
Molecular Genetic ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
P Value ◽  
Papillary Thyroid ◽  
Genetic Test Results

The Bethesda classification system for thyroid fine needle aspirate (FNA) is used to predict the risk of malignancy and to guide the management of thyroid nodules. We postulated that thyroid malignancies characterized as Bethesda III on FNA have more aggressive features than those classified as Bethesda IV. A retrospective chart review was performed to identify those who underwent thyroid surgery at a single tertiary hospital setting between 2015 and 2020. Associations between Bethesda category, molecular genetic test results, and histopathologic findings were examined. Out of 628 surgeries that were performed, 199 (54.2%) Bethesda III nodules and 216 (82.8%) Bethesda IV nodules were malignant. Of those that were malignant, 37 (18.6%) and 22 (10.2%) Bethesda III and Bethesda IV nodules showed aggressive features, respectively (p value = 0.014). There was a proportionally increased number of aggressive features in extra-thyroidal extension, lymph nodes metastasis, and all aggressive subtypes of papillary thyroid cancer in the Bethesda III category. Although Bethesda IV nodules are much more likely to be malignant (p value = 0.002), our study suggests that Bethesda III nodules that are resected are more likely to have aggressive features than Bethesda IV nodules, with a statistically significant increase in the solid variant of papillary thyroid cancer and lymph node metastasis.

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