Application of ultrasound, genetic testing, and clinical features in malignancy prediction of Bethesda III thyroid nodules: potential to avoid unnecessary surgery
10.3760/cma.j.cn115807-20241104-00342
- VernacularTitle:超声、基因检测与临床特征在Bethesda Ⅲ类甲状腺结节恶性预测中的应用：避免不必要手术的可能性
- Author:
Kehao CHEN
1
;
Lulu ZHENG
;
Linghui DAI
;
Yixuan LI
;
Jiabo QIN
;
Liu YANG
;
Jianfeng SANG
;
Wenxian GUAN
Author Information
1. 南京医科大学鼓楼临床医学院，南京 210008
- Publication Type:Journal Article
- Keywords:
Bethesda Ⅲ;
Ultrasound;
BRAF V600E gene;
Thyroid malignancy;
Fine-needle aspirations cytology
- From:
Chinese Journal of Endocrine Surgery
2025;19(3):363-367
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the predictive role of ultrasound, genetic testing, and clinical features in the malignancy risk of Bethesda Ⅲ thyroid nodules, and to explore strategies for optimizing treatment decisions.Methods:This retrospective study included 227 Bethesda Ⅲ thyroid nodules from patients who underwent surgical treatment at the Thyroid Surgery Department of Nanjing Drum Tower Hospital between Jan. 2020 and Dec. 2023. All patients underwent ultrasound evaluation and fine-needle aspiration. For nodules diagnosed as ultrasound, genetic testing, and clinical features were analyzed using univariate and multivariate regression to assess their association with malignancy.Results:Among the 227 nodules, 214 were malignant, resulting in a malignancy rate of 94.2%. The malignancy rate of thyroid nodules was 94.2%. In univariate analysis, age ( P=0.016), BRAF V600E gene mutation ( P<0.001), nodule size ( P=0.002), and TIRADS ( P<0.001) were significantly associated with malignancy in Bethesda Ⅲ thyroid nodules. Multivariate analysis confirmed that age ( OR=0.939, P=0.049) and BRAF V600E gene mutation ( OR=24.641, P<0.001) were significantly associated with thyroid nodule nature and served as independent predictive factors for malignancy. Conclusions:Genetic testing is an important method for predicting the malignancy of Bethesda Ⅲ thyroid nodules, and ultrasound also has high clinical value in assessing the malignancy risk of nodules. While some clinical features are highly correlated with nodule characteristics, they may not be practical in clinical application. For nodules classified as TIRADS 3 through ultrasound evaluation and negative for BRAF mutations, continued observation may be considered, whereas TIRADS 5 nodules or nodules with BRAF mutations should be prioritized for surgical treatment.
