{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:21:06Z","timestamp":1790266866116,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The risk of malignancy (ROM) in thyroid nodules with Bethesda III cytology ranges from 6% to 30%. Further stratification may aide the decision for diagnostic hemithyroidectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary general hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Bethesda III thyroid nodules consecutively resected between 2010 and 2016 are reviewed. Sonographic images are matched to the pathologic diagnoses and exported. Blinded to the diagnosis, 2 to 3 radiologists reached a consensus on the ACR\u2010TIRADS, EU\u2010TIRADS, and ATA classification of the nodules. A head and neck pathologist reviewed the cytology for nuclear atypia. Univariate and multivariate analyses are performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of a total of 243 nodules, 63 (26%) are malignant and 3 (1.2%) are NIFTP. Nuclear atypia, hypoechogenicity, intermediate and high\u2010risk categories in ACR\u2010TIRADS, EU\u2010TIRADS, or ATA are significantly associated with malignancy (including NIFTP) in both univariate and multivariate analysis (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001\u2010.028). The area\u2010under\u2010the\u2010receiver\u2010operator\u2010curve of the diagnostic model incorporating sex, nuclear atypia, and sonographic suspicion is 0.714, 0.695, 0.711, and 0.699, respectively, when sonographic suspicion is defined as hypoechogenicity, TR4\/5, EU\u2010TIRADS intermediate\/high\u2010risk, or ATA moderate\/high suspicion. In TR5, EU\u2010TIRADS or ATA high\u2010risk nodules or nodules with marked hypoechogenicity\/punctate echogenic foci\/irregular margins, nuclear atypia significantly increases the ROM from 6.3%\u20109.7% to 59.4%\u201075.0%. Majority of the cancers diagnosed by nuclear atypia and sonographic suspicion are papillary carcinomas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Diagnostic hemithyroidectomy is recommended in nodules with both AUS\u2010nuclear atypia and high sonographic suspicion. Improved identification of follicular\u2010patterned thyroid carcinomas is required to better manage the other Bethesda III nodules.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.1360","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T10:54:06Z","timestamp":1753786446000},"page":"848-858","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Refining the Management of Bethesda III Thyroid Nodules by Combining Nuclear Atypia with Sonographic Suspicion"],"prefix":"10.1002","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7191-5118","authenticated-orcid":false,"given":"Hao","family":"Li","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline C. Y.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Tan Tock Seng Hospital Singapore Singapore"},{"name":"Department of Otolaryngology Head and Neck Surgery, Khoo Teck Puat Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hau W.","family":"Khoo","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish M.","family":"Bundele","sequence":"additional","affiliation":[{"name":"Department of Pathology Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jereme Y. J.","family":"Gan","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest W. Z.","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming Y.","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian P. N.","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin Y. 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