Cytology versus histology in thyroid nodules: the Impact of Bethesda Categories III and IV
DOI:
https://doi.org/10.34631/sporl.3182Keywords:
thyroid nodule, fine-needle aspiration cytology (FNAC), accuracy, indeterminate cytologyAbstract
Aim: To evaluate diagnostic performance of fine-needle aspiration cytology (FNAC) in thyroid nodules and identify predictors of malignancy in Bethesda III–IV nodules.
Study Design: Single-center retrospective study.
Materials and Methods: Adults undergoing surgery between 2016–2025 were included. Cytology was classified as benign, suspicious/malignant, or indeterminate (Bethesda II, V–VI, III–IV, respectively), and histology as benign or malignant. Cytology–histology concordance and FNAC accuracy were evaluated using different approaches to indeterminate cytology. Associations between malignancy and clinical and ultrasound features were analyzed in indeterminate nodules.
Results: Among 72 patients, 23 had benign cytology, 14 suspicious/malignant, and 35 indeterminate. Cytology–histology concordance was weak but became excellent after excluding indeterminate cases (κ 0.266 vs 0.830; p<0.001). FNAC accuracy ranged from 56.9% to 91.9%, depending on handling of indeterminate cytology. No variable was significantly associated with malignancy in Bethesda III–IV nodules.
Conclusions: Bethesda III–IV nodules reduce FNAC accuracy. Identifying predictors of malignancy will improve surgical selection.
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Copyright (c) 2026 Ana Raquel Bastos, Manuel Sousa, Joana Freitas Rebelo, Manuela Ferreira, Leandro Ribeiro, Edite Coimbra Ferreira, Rita Osório, Pedro Oliveira
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