The national rate of malignancy among Bethesda III, IV, and V thyroid nodules is higher than expected: A NSQIP analysis

Aaron M Delman; Kevin M Turner; Allison M Ammann; Stephanie Sisak; Zishaan Farooqui; Tammy M Holm

doi:10.1016/j.surg.2022.06.049

The national rate of malignancy among Bethesda III, IV, and V thyroid nodules is higher than expected: A NSQIP analysis

Surgery. 2023 Mar;173(3):645-652. doi: 10.1016/j.surg.2022.06.049. Epub 2022 Oct 11.

Authors

Aaron M Delman¹, Kevin M Turner², Allison M Ammann², Stephanie Sisak³, Zishaan Farooqui³, Tammy M Holm⁴

Affiliations

¹ Department of Surgery, University of Cincinnati, OH; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati, OH. Electronic address: https://twitter.com/AaronDelman.
² Department of Surgery, University of Cincinnati, OH; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati, OH.
³ Department of Surgery, University of Cincinnati, OH.
⁴ Department of Surgery, University of Cincinnati, OH; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati, OH. Electronic address: tammy.holm@uc.edu.

PMID: 36229250
DOI: 10.1016/j.surg.2022.06.049

Abstract

Background: The Bethesda System for Reporting Thyroid Cytopathology was formalized in 2007 to stratify cytologic specimens based on their risk of malignancy. Several studies have reported significant variations between their institutional rate of malignancy compared to the Bethesda System for Reporting Thyroid Cytopathology. The objective of this study was to determine the national rate of malignancy for Bethesda III, Bethesda IV, and Bethesda V thyroid nodules.

Methods: From 2016 to 2019, patients with preoperative thyroid cytopathology and pathology results in National Surgical Quality Improvement database were included. The rate of malignancy was compared to the median the Bethesda System for Reporting Thyroid Cytopathology 2017, and risk factors associated with malignancy were identified for Bethesda III, Bethesda IV, and Bethesda V specimens.

Results: In total, 13,121 patients with preoperative cytopathology and postresection pathology were identified. The national rate of malignancy was significantly higher than the Bethesda System for Reporting Thyroid Cytopathology 2017 for Bethesda III (36.2% vs 12.0%, P < .01), Bethesda IV (36.7% vs 25.0%, P < .01), and Bethesda V (91.1% vs 52.5%, P < .01) specimens. Male sex was significantly associated with malignancy in Bethesda III, Bethesda IV, and Bethesda V nodules (Bethesda III, odds ratio: 1.20, [1.01-1.42]; Bethesda IV, odds ratio: 1.47, [1.27-1.71]; Bethesda V, odds ratio: 1.28, [1.03-1.58]). Younger age was associated with malignancy in Bethesda III patients under 55 (odds ratio: 1.23, [1.06-1.42]), Bethesda IV patients under 42 (odds ratio: 1.23, [1.06-1.43]), and Bethesda V patients aged less than 47 (odds ratio: 1.38, [1.15-1.67]).

Conclusions: This is the largest cohort study to describe the national rate of malignancy for Bethesda III, IV, and V specimens in the United States. These results reveal the national rate of malignancy is higher than the implied rate of malignancy reported to patients based on the Bethesda System for Reporting Thyroid Cytopathology. We recommend counseling patients regarding this increased rate of malignancy to set appropriate expectations after surgical intervention.

MeSH terms

Aged
Biopsy, Fine-Needle
Cohort Studies
Humans
Male
Postoperative Complications
Retrospective Studies
Thyroid Neoplasms* / epidemiology
Thyroid Neoplasms* / pathology
Thyroid Neoplasms* / surgery
Thyroid Nodule* / pathology
Thyroid Nodule* / surgery