Multinodularity Predicts Higher Incidental Malignancy in Bethesda Categories: A 1201-Patient Analysis
Bratislava Medical Journal, cilt.126, sa.11, ss.3166-3170, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 126 Sayı: 11
- Basım Tarihi: 2025
- Doi Numarası: 10.1007/s44411-025-00306-2
- Dergi Adı: Bratislava Medical Journal
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.3166-3170
- Anahtar Kelimeler: Thyroid nodule, Bethesda System, Multinodular goitre, Incidental carcinoma, Predictive model, Thyroidectomy
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: 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. Objectives: 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. Methods: 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. Results: 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). Conclusions: 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.