{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T21:09:23Z","timestamp":1790975363563,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T00:00:00Z","timestamp":1754092800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Endocrino Diabet &amp;amp; Metabol"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The appropriate management strategy for patients with thyroid nodules and indeterminate cytology on fine needle aspiration (FNA) remains unclear, especially in centres where molecular testing is not available. In this retrospective study, we aimed to identify factors predicting the risk of malignancy in these patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This retrospective study included consecutive patients with thyroid nodules with Bethesda III\/IV cytology who underwent surgical management at Hamad Medical Corporation, Qatar, between 01\/01\/2015 and 30\/08\/2023. Patients who did not undergo surgical management were excluded. We performed univariate and multivariate logistic regression analysis to assess the factors predicting the risk of malignancy in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 449 patients included in the study, the majority were females (72.2%). The mean (SD) age was 43.7\u2009\u00b1\u200910.7\u2009years. Arab was the most common ethnicity (56.6%), followed by South\u2010Asian (18.9%) and South\u2010East Asian (17.8%). Sonographic features of thyroid nodules were classified as ATA very low in 0.9%, low\u2010risk in 49.1%, intermediate\u2010risk in 42.05% and high\u2010risk in 7.95%. 86.2% had Bethesda III cytology and 13.8% had Bethesda IV cytology. Histopathology of thyroidectomy specimens confirmed malignancy in 179 (39.9%) patients. The malignancy rate in Bethesda III was 37.9%, while in Bethesda IV it was 51.6%. In multivariate logistic regression analysis, ATA intermediate (OR of 1.57 (1.03\u20132.4);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03) and high risk (OR of 3.92 (1.81\u20138.48);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) sonographic patterns were predictive of malignancy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with indeterminate thyroid nodule cytology and in the absence of molecular markers, the ATA sonographic pattern of thyroid nodules can guide decision\u2010 making for surgical management vs. surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/edm2.70076","type":"journal-article","created":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T17:14:13Z","timestamp":1754154853000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Outcomes of Patients With Bethesda\n                    <scp>III<\/scp>\n                    or\n                    <scp>IV<\/scp>\n                    Cytology on Fine Needle Aspiration of Thyroid Nodules\u2014A Retrospective Study"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1583-1539","authenticated-orcid":false,"given":"Adeel Ahmad","family":"Khan","sequence":"first","affiliation":[{"name":"Cleveland Clinic Akron General Department of Internal Medicine  Akron Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor Khalil Ebrahim","family":"Jasim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najlaa Essa A. H.","family":"Al\u2010Mannai","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7121-8574","authenticated-orcid":false,"given":"Fateen","family":"Ata","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajen","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Pathology Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Jaber","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Hamad Medical Corporation  Doha Qatar"},{"name":"Assistant Professor of Clinical Medicine Weill Cornell Medicine  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,2]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2008.09.019"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758\u20103284\u20102\u201011"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2023.0141"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/2473974x211015937"},{"key":"e_1_2_12_7_1","unstructured":"\u201cHMC's Thyroid Unit Records Increase in Malignant Cancer Cases Diagnosed Each Year.\u201d"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010370.pub2"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbm4.10479"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.26983"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1326134"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2013.0317"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcte.2021.100250"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.6061\/clinics\/2018\/e370"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00052184"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.1104607"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.15605\/jafes.038.01.14"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1393982"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics9030119"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics15050599"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000006564"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.24248"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.17924"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad313"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102265.2006.02625.x"}],"updated-by":[{"DOI":"10.1002\/edm2.70106","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000}}],"container-title":["Endocrinology, Diabetes &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/edm2.70076","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T06:06:06Z","timestamp":1764828366000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/edm2.70076"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,2]]},"references-count":24,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1002\/edm2.70076"],"URL":"https:\/\/doi.org\/10.1002\/edm2.70076","archive":["Portico"],"relation":{},"ISSN":["2398-9238","2398-9238"],"issn-type":[{"value":"2398-9238","type":"print"},{"value":"2398-9238","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,2]]},"assertion":[{"value":"2024-12-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70076"}}