{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T21:10:52Z","timestamp":1773004252676,"version":"3.50.1"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"vor","delay-in-days":223,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Endocrinology"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>\n                    <jats:bold>Objective:<\/jats:bold>\n                    The primary objective of this study was to further subclassify Bethesda III atypia of undetermined significance (AUS) cytological findings in thyroid lesions using fine\u2010needle aspiration cytology (FNAC). The secondary objective was to propose a novel scoring system to estimate the malignancy risk within these subcategories.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    We conducted a retrospective analysis of patients diagnosed with Bethesda III AUS who underwent thyroidectomy at King Khalid University Hospital, Riyadh, Saudi Arabia, from January 2017 to December 2024. Clinical, radiological, and pathological data\u2014including FNAC slides and surgical specimens\u2014were thoroughly reviewed. Cases classified as Bethesda III were further subclassified into six subtypes: III\u2010A (small follicular pattern, poorly cohesive cells, and minimal colloid), III\u2010B (nuclear and\/or cellular atypia), III\u2010C (cytological and architectural atypia), III\u2010D (predominantly Hurthle cells), III\u2010E (indeterminate atypia), and III\u2010F (atypical lymphoid cells suggestive of possible lymphoma). A structured malignancy risk scoring system was developed by integrating cytological subtypes, radiologic features (microcalcifications, irregular margins, and hypervascularity), clinical risk factors (family history and prior radiation), and patient age. Statistical analysis was performed using SPSS Version 22, with chi\u2010squared and Fisher\u2019s exact tests used to assess associations between variables and malignancy.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    A total of 338 cases were analyzed, with a mean age of 42\u2009\u00b1\u20095\u2009years and a female predominance. The malignancy distribution by subcategory was as follows: III\u2010A: 10.65% (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200936), III\u2010B: 54.73% (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009185), III\u2010C: 22.49% (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200976), III\u2010D: 5.03% (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200917), III\u2010E: 7.69% (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200926), and III\u2010F: 0.3% (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20091). Significant associations were found between malignancy and both cytological subcategory and presence of high\u2010risk ultrasound features (\n                    <jats:italic>p<\/jats:italic>\n                    &lt; 0.05). The proposed scoring system stratified patients into three risk groups: low (scores 0\u20132), moderate (2.5\u20134), and high (\u2265 4.5), offering a predictive framework for clinical decision\u2010making.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    This study highlights the heterogeneity within Bethesda III AUS nodules and supports subclassification as a meaningful step toward more accurate malignancy risk assessment. The proposed scoring system may serve as a practical tool to guide individualized management decisions. Further prospective validation is warranted.\n                  <\/jats:p>","DOI":"10.1155\/ije\/6736469","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T08:35:18Z","timestamp":1754987718000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Scoring System for AUS Thyroid Nodule"],"prefix":"10.1155","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2934-1565","authenticated-orcid":false,"given":"Nuha A.","family":"Alsaleh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7653-5683","authenticated-orcid":false,"given":"Mohammed A.","family":"Alswayyed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4895-1553","authenticated-orcid":false,"given":"Shatha A.","family":"Alduraywish","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3101-6912","authenticated-orcid":false,"given":"Budur T.","family":"Althobaiti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3128-6661","authenticated-orcid":false,"given":"Beshayer A.","family":"Alhentti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9003-4190","authenticated-orcid":false,"given":"Afnan A.","family":"Alzayed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9698-9214","authenticated-orcid":false,"given":"Monirah M.","family":"Alsalouli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8506-8949","authenticated-orcid":false,"given":"Abdullah I.","family":"Aljunaydil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8537-0550","authenticated-orcid":false,"given":"Malak A.","family":"Alzahrani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"key":"e_1_2_10_1_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2009.0274"},{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2023.0141"},{"key":"e_1_2_10_3_2","volume-title":"The Bethesda System for Reporting Thyroid Cytopathology: A Fiveyear Retrospective Review of One Center Experience","author":"Mufti S. T.","year":"2012"},{"key":"e_1_2_10_4_2","article-title":"Anaplastic Thyroid Carcinoma","author":"Haddad I.","year":"2015","journal-title":"Journal of the National Comprehensive Cancer Network"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/dc.23472"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/000313481408000834"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mpdhp.2023.07.009"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2010.01.003"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1159\/000334218"},{"key":"e_1_2_10_10_2","volume-title":"Classification of Thyroid Fine-Needle Aspiration Cytology Into Bethesda Categories: An Institutional Experience and Review of the Literature","author":"Alshaikh S.a","year":"2018"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/pap.0b013e3182666398"},{"key":"e_1_2_10_12_2","volume-title":"Thyroid Nodules and Differentiated Thyroid Cancer: Update on the Brazilian Consensus","author":"Ros\u00e1rio"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.3348\/kjr.2024.0292"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.3348\/kjr.2015.16.2.391"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8095378"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/4521984"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13044-023-00169-1"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.20287"}],"container-title":["International Journal of Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/ije\/6736469","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/ije\/6736469","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/ije\/6736469","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T18:31:40Z","timestamp":1772994700000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/ije\/6736469"}},"subtitle":[],"editor":[{"given":"Jaya","family":"Bharati","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1155\/ije\/6736469"],"URL":"https:\/\/doi.org\/10.1155\/ije\/6736469","archive":["Portico"],"relation":{},"ISSN":["1687-8337","1687-8345"],"issn-type":[{"value":"1687-8337","type":"print"},{"value":"1687-8345","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2025-05-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"6736469"}}