Annals of Surgical Oncology

, Volume 21, Issue 11, pp 3528–3533

Bethesda III Thyroid Nodules: The Role of Ultrasound in Clinical Decision Making

  • Olov Norlén
  • Aleksandra Popadich
  • Schelto Kruijff
  • Anthony J. Gill
  • Leba M. Sarkis
  • Leigh Delbridge
  • Mark Sywak
  • Stan Sidhu
Endocrine Tumors

DOI: 10.1245/s10434-014-3749-8

Cite this article as:
Norlén, O., Popadich, A., Kruijff, S. et al. Ann Surg Oncol (2014) 21: 3528. doi:10.1245/s10434-014-3749-8

Abstract

Background

Assessment for thyroid nodules includes ultrasound (US) and cytology according to the Bethesda classification. There is no firm consensus regarding clinical management for nodules classified as Bethesda III. Our aim was investigate the value of US to predict malignancy in these nodules.

Methods

Patients with Bethesda III nodules who underwent thyroid surgery from July 2011 to July 2013 were included. Inclusion criteria mandated that US were available for review by two observers blinded to each other’s results and histological outcome. The nodules were scrutinized with six US criteria: hypoechoic attenuation (HA), irregular margins (IM), taller than wide, microcalcifications (MC), loss of halo, and increased central vascularity. Disagreements between observers were solved by consensus.

Results

There were 141 patients (121 women) with a mean age of 55 years. Mean nodule size was 25 mm. The malignancy rate was 13 %. Interobserver ratios were moderate to very strong for all six predictors (kappa = 0.60–0.94). However, only HA, IM, and MC were predictors of malignancy by univariate analysis (all p < 0.002). Logistic regression revealed an odds ratio of malignancy versus no malignancy for HA 4.8, IM 3.3, and MC 4.0 (all p < 0.05). The positive and negative predictive value for malignancy when having one or more of these three criteria was 22 % and 98 %, respectively.

Conclusion

HA, IM, and MC were predictors of malignancy in Bethesda III nodules. In addition, the negative predictive value for any of these three criteria was high; a nodule that lacks all of these three criteria is thus unlikely to be malignant.

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Olov Norlén
    • 1
    • 2
  • Aleksandra Popadich
    • 1
  • Schelto Kruijff
    • 1
  • Anthony J. Gill
    • 3
    • 4
  • Leba M. Sarkis
    • 3
    • 4
  • Leigh Delbridge
    • 1
  • Mark Sywak
    • 1
  • Stan Sidhu
    • 1
  1. 1.University of Sydney Endocrine Surgery UnitSydneyAustralia
  2. 2.Department of Surgical SciencesUppsala UniversityUppsalaSweden
  3. 3.Department of Anatomical PathologyRoyal North Shore HospitalSydneyAustralia
  4. 4.University of SydneySydneyAustralia