Work

Multinodularity Predicts Higher Incidental Malignancy in Bethesda Categories: A 1201-Patient Analysis

Year: 2025

Type: article

Abstract: Thyroid nodules (TNs) are increasingly detected with high-resolution ultrasonography, yet current risk-stratification systems may underestimate malignancy in iodine-deficient, multinodular populations. Evidence guiding surgical extent in such settings remains limited. To quantify malignancy rates across Bethesda categories in an endemic multinodular goitre cohort, identify predictors of incidental carcinoma, and propose a context-specific algorithm that minimises unnecessary total thyroidectomies while maintaining oncological safety. We retrospectively analysed 1,201 consecutive thyroidectomies performed between 2013 and 2018. Pre-operative variables (age, sex, number of nodules on ultrasound, largest-nodule diameter, Bethesda I–VI cytology) were correlated with final histopathology. Multivariable logistic regression examined the effect of ≥ 3 nodules on incidental cancer after adjustment for covariates; model performance was assessed with AUC and Hosmer–Lemeshow goodness-of-fit. Observed cancer rates by Bethesda class markedly exceeded 2017 benchmarks: I 23.7%, II 22.4%, III 34.7%, IV 52.1%, V 92.0%, VI 100% (all p < 0.001 vs upper reference limits). Incidental carcinomas constituted 34.4% micro- and 65.6% classical papillary cancers. Multivariable analysis identified ≥ 3 nodules as an independent predictor of incidental carcinoma (OR 4.13, 95% CI 2.65–6.45; p < 0.001), whereas Bethesda V status conferred a 77% lower risk relative to Bethesda III (OR 0.23, 95% CI 0.07–0.73; p = 0.014). Age and sex were non-significant. The model demonstrated good discrimination (AUC 0.79) and calibration (Hosmer–Lemeshow p = 0.46). In iodine-deficient multinodular goitre, malignancy risks in Bethesda I–IV greatly exceed global norms. Incorporating nodule burden into risk assessment improves prediction of incidental carcinoma and supports a selective, patient-centred surgical approach. Regional epidemiology should inform guideline adaptation and follow-up intervals to reduce both overtreatment and missed cancers.

Source: Bratislavské lekárske listy/Bratislava medical journal

DOI: 10.1007/s44411-025-00306-2

Authors: Yusuf Yunus Korkmaz, Yigit Soytas, Gamze Citlak

Institutions: İstanbul Başakşehir Çam ve Sakura Şehir Hastanesi, Martin Luther University Halle-Wittenberg, Haseki Eğitim ve Araştırma Hastanesi, Sağlık Bilimleri Üniversitesi

Language: English

Topic: Thyroid Cancer Diagnosis and Treatment

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,590