Predictors of Malignancy in Patients With a Repeated Diagnosis of Bethesda Category in Thyroid Nodules Who Underwent Surgery

ABSTRACT Fine Needle Aspiration Biopsy (FNAB) is a diagnostic modality commonly utilized in thyroid nodules, and the incorporation of the Bethesda System further enhances its diagnostic performance. However, category III nodules according to the Bethesda System are challenging due to their suspicious cytology, which renders an indeterminate risk of malignancy and requires repeated FNAB. Previous studies emphasize the possible advantage of repeated FNAB and some clinical and radiological markers in stratification of malignancy risk, though the exact predictive factors for malignancy among Bethesda III cases remain inadequately known. The aim of this study is to focus on the analysis of clinical and radiological predictors influencing malignancy risk in patients with repeated Bethesda III diagnoses. In this retrospective study, the authors reviewed three hospitals from 2015 to 2022 and retrospectively identified 120 patients with a repeat FNAB diagnosis of Bethesda III who underwent thyroid surgery. Demographic, clinical, and ultrasound data were collected, and logistic regression was performed to identify independent predictors of malignancy. The rate of malignancy was 39.2%, which was much higher than in previous reports. There were strong associations with gender, male gender, and increased risk of malignancy, with a cumulative odds ratio of 3.67. These findings suggest that repeat FNAB in association with patient‐specific factors and nodule‐specific factors, such as gender and ultrasound findings, may improve the prediction of the risk of malignancy in Bethesda III thyroid nodules. This could translate into better clinical decision‐making, avoiding unnecessary surgery, and improved outcomes for the patient overall.