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Preoperative Clinical Factors Associated with High-Risk Thyroid Cytology (Bethesda V-VI): A Retrospective Study of a Thyroidectomy Cohort

Year: 2026

Type: article

Abstract: Objective: To identify preoperative clinical factors associated with high-risk thyroid cytology (Bethesda V-VI) in patients undergoing thyroidectomy and to explore their association with cytological reclassification in initially non-high-risk nodules.Methods: In this single-center retrospective study, 438 consecutive patients undergoing thyroidectomy between 2024 and 2025 were evaluated.After excluding Bethesda I cases, 415 patients were included.High-risk cytology (Bethesda V-VI) was the primary outcome.Age, sex, nodule size, bilateral involvement, toxic functional status, and cervical lymphadenopathy were assessed using logistic regression.A prespecified sensitivity analysis was restricted to Bethesda V cytology.Results: High-risk cytology was identified in 151 patients (36.4%).In multivariable analysis, toxic functional status (odds ratio [OR], 0.20; 95% confidence interval [CI], 0.07-0.54;p = 0.002) and larger nodule size (OR, 0.21; 95% CI, 0.15-0.30;p < 0.001) were independently associated with lower odds of high-risk cytology, whereas cervical lymphadenopathy was associated with higher odds (OR, 4.17; 95% CI, 1.87-9.31;p < 0.001).No independent associations were observed for age, sex, or bilaterality.The associations with toxic functional status and nodule size remained consistent in the sensitivity analysis.Among 127 patients who underwent repeat fine-needle aspiration, 19 (15.0%) were reclassified to high-risk cytology, with consistent findings.Conclusion: Toxic functional status was associated with a lower likelihood of high-risk thyroid cytology, whereas cervical lymphadenopathy was associated with a higher likelihood.Similar patterns among patients undergoing repeat aspiration suggest that these routinely available clinical features may support follow-up decisions for initially non-high-risk nodules.Prospective studies are warranted to validate these findings.

Source: Forbes Journal of Medicine

DOI: 10.4274/forbes.galenos.2026.69345

Authors: Bahattin BAYAR, Yılmaz TÜRK

Institutions: Sağlık Bilimleri Üniversitesi, Ankara Etlik City Hospital

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: diamond

OpenAlex ID: W7204155674