{"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":1790266866149,"version":"4.1.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"Proof of Concept Program of Zhongguancun Science City and Peking University Third Hospital","award":["HDCXZHKC2022210"],"award-info":[{"award-number":["HDCXZHKC2022210"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Surg Onc"],"DOI":"10.1186\/s12957-025-04095-4","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T11:23:45Z","timestamp":1763465025000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Development of a malignancy risk prediction model combining ultrasound and cytology for Bethesda category III thyroid nodules"],"prefix":"10.1186","volume":"23","author":[{"given":"Fan","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Mei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"4095_CR1","unstructured":"Mulita F, Anjum F. Thyroid Adenoma. [Updated 2023 Apr 27]. In: StatPearls. Treasure Island: StatPearls Publishing; 2025. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK562252\/"},{"issue":"26","key":"4095_CR2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000033822","volume":"102","author":"L Keskin","year":"2023","unstructured":"Keskin L, Karahan D, Yaprak B. Comparison of thyroid fine needle aspiration biopsy and ultrasonography results. Medicine. 2023;102(26):e33822.","journal-title":"Medicine"},{"issue":"2","key":"4095_CR3","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1007\/s12020-020-02441-y","volume":"70","author":"J Zhou","year":"2020","unstructured":"Zhou J, Yin L, Wei X, et al. 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS. Endocrine. 2020;70(2):256\u201379.","journal-title":"Endocrine"},{"issue":"5","key":"4095_CR4","first-page":"e8202","volume":"12","author":"M Al Dawish","year":"2020","unstructured":"Al Dawish M, Alwin Robert A, Al Shehri K, et al. Risk stratification of thyroid nodules with Bethesda III category: the experience of a territorial healthcare hospital. Cureus. 2020;12(5):e8202.","journal-title":"Cureus"},{"issue":"3","key":"4095_CR5","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1016\/j.surg.2022.06.049","volume":"173","author":"AM Delman","year":"2023","unstructured":"Delman AM, Turner KM, Ammann AM, Sisak S, Farooqui Z, Holm TM. The national rate of malignancy among Bethesda III, IV, and V thyroid nodules is higher than expected: a NSQIP analysis. Surgery. 2023;173(3):645\u201352.","journal-title":"Surgery"},{"issue":"11","key":"4095_CR6","doi-asserted-by":"publisher","first-page":"1954","DOI":"10.21037\/gs-24-310","volume":"13","author":"L Zhong","year":"2024","unstructured":"Zhong L, Shi L, Lai J, Hu Y, Gu L. Combined model integrating clinical, radiomics, BRAF(V600E) and ultrasound for differentiating between benign and malignant indeterminate cytology (Bethesda III) thyroid nodules: a bi-center retrospective study. Gland Surg. 2024;13(11):1954\u201364.","journal-title":"Gland Surg"},{"issue":"9","key":"4095_CR7","first-page":"1039","volume":"33","author":"SZ Ali","year":"2023","unstructured":"Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA. The 2023 Bethesda system for reporting thyroid cytopathology. Thyroid. 2023;33(9):1039\u201344.","journal-title":"Thyroid"},{"issue":"5","key":"4095_CR8","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1016\/j.ultrasmedbio.2021.01.019","volume":"47","author":"P Moraes","year":"2021","unstructured":"Moraes P, Takahashi MS, Vanderlei F, et al. Multiparametric ultrasound evaluation of the thyroid: elastography as a key tool in the risk prediction of undetermined nodules (Bethesda III and IV)-histopathological correlation. Ultrasound Med Biol. 2021;47(5):1219\u201326.","journal-title":"Ultrasound Med Biol"},{"issue":"12","key":"4095_CR9","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1002\/cncy.22489","volume":"129","author":"AM Onken","year":"2021","unstructured":"Onken AM, VanderLaan PA, Hennessey JV, Hartzband P, Nishino M. Combined molecular and histologic end points inform cancer risk estimates for thyroid nodules classified as atypia of undetermined significance. Cancer Cytopathol. 2021;129(12):947\u201355.","journal-title":"Cancer Cytopathol"},{"issue":"7","key":"4095_CR10","doi-asserted-by":"publisher","first-page":"1772","DOI":"10.1002\/hed.27389","volume":"45","author":"C van Kinschot","year":"2023","unstructured":"van Kinschot C, Soekhai VR, de Bekker-Grob EW, et al. Preferences of patients, clinicians, and healthy controls for the management of a Bethesda III thyroid nodule. Head Neck. 2023;45(7):1772\u201381.","journal-title":"Head Neck"},{"issue":"12","key":"4095_CR11","doi-asserted-by":"publisher","first-page":"6624","DOI":"10.1007\/s00330-020-07023-0","volume":"30","author":"Y Qiu","year":"2020","unstructured":"Qiu Y, Xing Z, Liu J, Peng Y, Zhu J, Su A. Diagnostic reliability of elastography in thyroid nodules reported as indeterminate at prior fine-needle aspiration cytology (FNAC): a systematic review and bayesian meta-analysis. Eur Radiol. 2020;30(12):6624\u201334.","journal-title":"Eur Radiol"},{"issue":"2","key":"4095_CR12","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1007\/s12020-024-03737-z","volume":"85","author":"KN Rao","year":"2024","unstructured":"Rao KN, Randolph GW, Lopez F, et al. Assessment of the risk of malignancy in Bethesda III thyroid nodules: a comprehensive review. Endocrine. 2024;85(2):473\u201392.","journal-title":"Endocrine"},{"issue":"1","key":"4095_CR13","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-020-0530-9","volume":"20","author":"B Yaprak Bayrak","year":"2020","unstructured":"Yaprak Bayrak B, Eruyar AT. Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology. BMC Endocr Disord. 2020;20(1):48.","journal-title":"BMC Endocr Disord"},{"issue":"11","key":"4095_CR14","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1002\/dc.24522","volume":"48","author":"N Kumar","year":"2020","unstructured":"Kumar N, Gupta R, Gupta S. Molecular testing in diagnosis of indeterminate thyroid cytology: trends and drivers. Diagn Cytopathol. 2020;48(11):1144\u201351.","journal-title":"Diagn Cytopathol"},{"issue":"2","key":"4095_CR15","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s12022-020-09643-0","volume":"32","author":"H Ngo","year":"2021","unstructured":"Ngo H, Nguyen T, Vu TH, et al. Impact of molecular testing on the management of indeterminate thyroid nodules among Western and Asian countries: a systematic review and meta-analysis. Endocr Pathol. 2021;32(2):269\u201379.","journal-title":"Endocr Pathol"},{"issue":"2","key":"4095_CR16","doi-asserted-by":"publisher","DOI":"10.1177\/2473974X211015937","volume":"5","author":"V Kuta","year":"2021","unstructured":"Kuta V, Forner D, Azzi J, et al. Treatment choices in managing Bethesda III and IV thyroid nodules: a Canadian multi-institutional study. OTO Open. 2021;5(2):2473974X211015937.","journal-title":"OTO Open"},{"issue":"17","key":"4095_CR17","doi-asserted-by":"publisher","first-page":"4287","DOI":"10.3390\/cancers15174287","volume":"15","author":"D S\u0142owi\u0144ska-Klencka","year":"2023","unstructured":"S\u0142owi\u0144ska-Klencka D, Popowicz B, Kulczycka-Wojdala D, et al. Effective use of microRNA, BRAF and sonographic risk assessment in Bethesda III thyroid nodules requires a different approach to nodules with features of nuclear atypia and other types of atypia. Cancers (Basel). 2023;15(17):4287.","journal-title":"Cancers (Basel)"},{"issue":"5","key":"4095_CR18","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1002\/cncy.22544","volume":"130","author":"CE Cherella","year":"2022","unstructured":"Cherella CE, Hollowell ML, Smith JR, et al. Subtype of atypia on cytology and risk of malignancy in pediatric thyroid nodules. Cancer Cytopathol. 2022;130(5):330\u20135.","journal-title":"Cancer Cytopathol"},{"issue":"5","key":"4095_CR19","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/j.jacr.2017.01.046","volume":"14","author":"FN Tessler","year":"2017","unstructured":"Tessler FN, Middleton WD, Grant EG, et al. ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee. J Am Coll Radiol. 2017;14(5):587\u201395.","journal-title":"J Am Coll Radiol"},{"issue":"8","key":"4095_CR20","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1002\/cncy.22417","volume":"129","author":"H Zhao","year":"2021","unstructured":"Zhao H, Guo H, Zhao L, et al. Subclassification of the Bethesda category III (AUS\/FLUS): a study of thyroid FNA cytology based on ThinPrep slides from the National cancer center in China. Cancer Cytopathol. 2021;129(8):642\u20138.","journal-title":"Cancer Cytopathol"},{"key":"4095_CR21","doi-asserted-by":"crossref","unstructured":"Jin X, Jing X, Smola B, Heider A. Malignant risk of pediatric Bethesda category III thyroid nodules subcategorized by nuclear atypia and other: A single institution experience. Cancer Cytopathol. 2024;132(9):564\u20138.","DOI":"10.1002\/cncy.22831"},{"issue":"2","key":"4095_CR22","doi-asserted-by":"publisher","first-page":"143","DOI":"10.5603\/EP.a2021.0018","volume":"72","author":"F Mulita","year":"2021","unstructured":"Mulita F, Plachouri MK, Liolis E, Vailas M, Panagopoulos K, Maroulis I. Patient outcomes following surgical management of thyroid nodules classified as Bethesda category III (AUS\/FLUS). Endokrynol Pol. 2021;72(2):143\u20134.","journal-title":"Endokrynol Pol"},{"issue":"5","key":"4095_CR23","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1159\/000478927","volume":"6","author":"G Russ","year":"2017","unstructured":"Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European thyroid association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur Thyroid J. 2017;6(5):225\u201337.","journal-title":"Eur Thyroid J"},{"issue":"9","key":"4095_CR24","doi-asserted-by":"publisher","first-page":"1947","DOI":"10.1002\/hed.25179","volume":"40","author":"VY Park","year":"2018","unstructured":"Park VY, Lee HS, Kim EK, Kwak JY, Yoon JH, Moon HJ. Frequencies and malignancy rates of 6-tiered Bethesda categories of thyroid nodules according to ultrasound assessment and nodule size. Head Neck. 2018;40(9):1947\u201354.","journal-title":"Head Neck"},{"issue":"2","key":"4095_CR25","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1002\/cncy.22217","volume":"128","author":"C Bellevicine","year":"2020","unstructured":"Bellevicine C, Migliatico I, Sgariglia R, et al. Evaluation of BRAF, RAS, RET\/PTC, and PAX8\/PPARg alterations in different Bethesda diagnostic categories: A multicentric prospective study on the validity of the 7-gene panel test in 1172 thyroid FNAs deriving from different hospitals in South Italy. Cancer Cytopathol. 2020;128(2):107\u201318.","journal-title":"Cancer Cytopathol"},{"issue":"3","key":"4095_CR26","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1111\/cen.14799","volume":"98","author":"LB Eidt","year":"2023","unstructured":"Eidt LB, Nunes de Oliveira C, Lagos Y, et al. A prospective comparison of ACR-TIRADS and EU-TIRADS in thyroid nodule assessment for FNA-US. Clin Endocrinol (Oxf). 2023;98(3):415\u201325.","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"12","key":"4095_CR27","volume":"16","author":"EZ Azzam","year":"2024","unstructured":"Azzam EZ, Salah MA, Aboelwafa WA, Essam RM, Bondok ME. Rates and predictors of malignancy in Bethesda III and IV thyroid nodules: a prospective study. Cureus. 2024;16(12):e76615.","journal-title":"Cureus"},{"issue":"6","key":"4095_CR28","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1111\/cyt.13273","volume":"34","author":"L Dhar","year":"2023","unstructured":"Dhar L, Singh M, Jain SL, et al. Correlation of ultrasound-based TIRADS and the Bethesda system for reporting of thyroid cytopathology: A study in a tertiary care centre. Cytopathology. 2023;34(6):590\u20136.","journal-title":"Cytopathology"},{"key":"4095_CR29","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.jss.2020.12.009","volume":"262","author":"G Scerrino","year":"2021","unstructured":"Scerrino G, Cocorullo G, Mazzola S, et al. Improving diagnostic performance for thyroid nodules classified as Bethesda category III or IV: how and by whom ultrasonography should be performed. J Surg Res. 2021;262:203\u201311.","journal-title":"J Surg Res"},{"key":"4095_CR30","doi-asserted-by":"publisher","unstructured":"Mulita F, Iliopoulos F, Tsilivigkos C, et al. Cancer rate of Bethesda category II thyroid nodules. Med Glas (Zenica). 2022;19(1). https:\/\/doi.org\/10.17392\/1413-21.","DOI":"10.17392\/1413-21"}],"container-title":["World Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-025-04095-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12957-025-04095-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-025-04095-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:04:39Z","timestamp":1763510679000},"score":1,"resource":{"primary":{"URL":"https:\/\/wjso.biomedcentral.com\/articles\/10.1186\/s12957-025-04095-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,18]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4095"],"URL":"https:\/\/doi.org\/10.1186\/s12957-025-04095-4","relation":{},"ISSN":["1477-7819"],"issn-type":[{"value":"1477-7819","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,18]]},"assertion":[{"value":"7 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Approval for this study was obtained from Peking University Third Hospital Medical Science Research Ethics Committee. The registration number is IRB00006761- M20250374.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed consent was granted by Peking University Third Hospital Medical Science Research Ethics Committee due to the retrospective nature of the data collection and analysis.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"438"}}