{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:08:35Z","timestamp":1791209315894,"version":"4.1.0"},"reference-count":238,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007689","name":"Universidade de Aveiro","doi-asserted-by":"publisher","award":["BI\/REIT\/12631\/2025"],"award-info":[{"award-number":["BI\/REIT\/12631\/2025"]}],"id":[{"id":"10.13039\/100007689","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019370","name":"Foundation for Science and Technology","doi-asserted-by":"publisher","award":["UID\/04501\/2025, 2023.02418.BD, UI\/BD\/151352\/2021"],"award-info":[{"award-number":["UID\/04501\/2025, 2023.02418.BD, UI\/BD\/151352\/2021"]}],"id":[{"id":"10.13039\/501100019370","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Thyroid nodules (TNs) are prevalent, particularly in women and older adults, yet only a minority are malignant. Clinical decisions on biopsy and follow-up are complicated by selective use of fine-needle aspiration cytology, indeterminate results, and efforts to limit unnecessary procedures. We systematically identified and synthesized sociodemographic, laboratory, and ultrasonographic (US) factors associated with malignancy in TNs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      PubMed, Scopus, Web of Science, and EMBASE were searched (PROSPERO CRD42024557085). Two reviewers independently screened studies, extracted data, and assessed risk of bias (Joanna Briggs Institute tools). Random-effects meta-analyses were performed for predictors reported in \u22655 studies, with heterogeneity quantified using I\n                      <jats:sup>2<\/jats:sup>\n                      . Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Malignancy was defined according to each study\u2019s reference standard (histology and\/or cytology). Sensitivity analyses assessed robustness across diagnostic method and key study-level characteristics (e.g. geographic region and sample size).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 35,359 records, 194 studies met the inclusion criteria. Of these, 47 with poolable crude ORs (predictors reported in \u22655 studies) contributed to meta-analysis, and the remainder to qualitative synthesis. Male sex, family history of thyroid cancer, higher thyroid-stimulating hormone levels, and several US features (including hypoechogenicity, solid composition, calcifications\/microcalcifications, taller-than-wide shape, and irregular margins) were associated with higher odds of malignancy, whereas increasing age and larger nodule size showed inverse associations, though with substantial between-study heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Malignancy in TNs reflects both patient-related and nodule-specific characteristics. Integrating these factors may support pre-biopsy risk assessment and more consistent biopsy and follow-up decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:ext-link>\n                      , identifier CRD42024557085.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1885823","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:43:20Z","timestamp":1787719400000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sociodemographic and clinical predictors of malignancy in thyroid nodules: a systematic review and 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