{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:57:31Z","timestamp":1786971451371,"version":"build-2736575974"},"reference-count":51,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T00:00:00Z","timestamp":1649808000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005888","name":"Medical University of Lodz","doi-asserted-by":"publisher","award":["503\/1-153-05\/503-11-001"],"award-info":[{"award-number":["503\/1-153-05\/503-11-001"]}],"id":[{"id":"10.13039\/501100005888","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The aim of this study was to evaluate the risk of malignancy (RoM) in category III thyroid nodules of the Bethesda system in patients with and without Hashimoto thyroiditis (HT) and to analyze whether obtaining category III with a repeat FNA (rFNA) increases RoM. The study included 563 HT and 1250 non-HT patients; rFNA was performed in 349 and 575 patients, and surgical treatment in 160 and 390, respectively. There was no difference in RoM between HT and non-HT patients in the whole examined population (lower limit of RoM), nor in operated patients (upper limit of RoM), HT: 5.0\u201317.5%, non-HT: 4.7\u201315.1%. RoM in patients with AUS nodules (with nuclear atypia) was similar in both groups (HT: 21.7\u201340.0%, non-HT: 16.9\u201341.4%), as it was in patients with FLUS nodules (with architectural atypia) (HT: 3.5\u201313.3%, non-HT: 4.0\u201313.0%). In patients from both groups together, with category III diagnosed twice and AUS identified at least once, RoM was 16.7\u201350.0% and it was higher than that in patients with FLUS nodule diagnosed twice: 3.2\u201313.0% (p &lt; 0.005). Concluding, RoM in category III nodules is not affected by the presence of HT. Subcategorization of category III nodules (FLUS vs. AUS) may provide guidance toward further follow-up or surgery in both groups.<\/jats:p>","DOI":"10.3390\/cancers14081971","type":"journal-article","created":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T21:33:42Z","timestamp":1649885622000},"page":"1971","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Hashimoto\u2019s Thyroiditis Does Not Influence the Malignancy Risk in Nodules of Category III in the Bethesda System"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5617-0418","authenticated-orcid":false,"given":"Dorota","family":"S\u0142owi\u0144ska-Klencka","sequence":"first","affiliation":[{"name":"Department of Morphometry of Endocrine Glands, Medical University of Lodz, Pomorska Street 251, 92-213 \u0141\u00f3d\u017a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo\u017cena","family":"Popowicz","sequence":"additional","affiliation":[{"name":"Department of Morphometry of Endocrine Glands, Medical University of Lodz, Pomorska Street 251, 92-213 \u0141\u00f3d\u017a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4581-0897","authenticated-orcid":false,"given":"Mariusz","family":"Klencki","sequence":"additional","affiliation":[{"name":"Department of Morphometry of Endocrine Glands, Medical University of Lodz, Pomorska Street 251, 92-213 \u0141\u00f3d\u017a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1309\/AJCPPHLWMI3JV4LA","article-title":"NCI Thyroid FNA State of the Science Conference. The Bethesda system for reporting thyroid cytopathology","volume":"132","author":"Cibas","year":"2009","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1089\/thy.2017.0500","article-title":"The 2017 Bethesda system for reporting thyroid cytopathology","volume":"27","author":"Cibas","year":"2017","journal-title":"Thyroid"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1002\/cncy.22228","article-title":"Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta-analysis","volume":"128","author":"Vuong","year":"2020","journal-title":"Cancer Cytopathol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1002\/cncy.21412","article-title":"Should the thyroid AUS\/FLUS category be further stratified by malignancy risk?","volume":"122","author":"Nishino","year":"2014","journal-title":"Cancer Cytopathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1016\/j.surg.2014.08.026","article-title":"Malignancy risk and reproducibility associated with atypia of undetermined significance on thyroid cytology","volume":"156","author":"Mathur","year":"2014","journal-title":"Surgery"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/cyt.12352","article-title":"Risk of malignancy according to sub-classification of the atypia of undetermined significance or follicular lesion of undetermined significance (AUS\/FLUS) category in the Bethesda system for reporting thyroid cytopathology","volume":"28","author":"Kim","year":"2017","journal-title":"Cytopathology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1764","DOI":"10.21037\/gs-20-555","article-title":"Atypia of undetermined significance\/follicular lesion of undetermined significance: Asian vs. non-Asian practice, and the Singapore experience","volume":"9","author":"Ooi","year":"2020","journal-title":"Gland Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3913","DOI":"10.1245\/s10434-018-6826-6","article-title":"Both ultrasound features and nuclear atypia are associated with malignancy in thyroid nodules with atypia of undetermined significance","volume":"25","author":"Eisa","year":"2018","journal-title":"Ann. Surg. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1530\/EJE-12-0993","article-title":"Low malignancy risk of thyroid follicular lesion of undetermined significance in patients from post-endemic areas","volume":"168","author":"Wojtaszek","year":"2013","journal-title":"Eur. J. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1097\/PAT.0000000000000168","article-title":"The Australian experience with the Bethesda classification system for thyroid fine n aspiration biopsies","volume":"46","author":"Sarkis","year":"2014","journal-title":"Pathology"},{"key":"ref_11","first-page":"100175","article-title":"Incidence and malignancy rates classified by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)\u2014An 8-year tertiary center experience in Thailand","volume":"16","author":"Thewjitcharoen","year":"2018","journal-title":"J. Clin. Transl. Endocrinol."},{"key":"ref_12","first-page":"195","article-title":"The indeterminate thyroid fine-needle aspiration: Experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference","volume":"117","author":"Nayar","year":"2009","journal-title":"Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1002\/dc.21754","article-title":"The Bethesda system for reporting thyroid cytopathology: An experience of 1,382 cases in a community practice setting with the implication for risk of neoplasm and risk of malignancy","volume":"40","author":"Wu","year":"2012","journal-title":"Diagn. Cytopathol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1210\/js.2018-00427","article-title":"The impact of Hashimoto thyroiditis on thyroid nodule cytology and risk of thyroid cancer","volume":"3","author":"Stuart","year":"2019","journal-title":"J. Endocr. Soc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s40618-017-0757-0","article-title":"High prevelance of papillary thyroid carcinoma in nodular Hashimoto\u2019s thyroiditis at the firs diagnosis and during the follow-up","volume":"41","author":"Boi","year":"2018","journal-title":"J. Endocrinol. Investig."},{"key":"ref_16","first-page":"3474","article-title":"Hashimoto\u2019s thyroiditis elicits decreased diagnostic efficacy of thyroid nodule ultrasound-guided fine needle aspiration","volume":"12","author":"Meng","year":"2019","journal-title":"Int. J. Clin. Exp. Pathol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"S\u0142owi\u0144ska-Klencka, D., Wojtaszek-Nowicka, M., Klencki, M., Wysocka-Konieczna, K., and Popowicz, B. (2021). The Presence of Hypoechoic Micronodules in Patients with Hashimoto\u2019s Thyroiditis Increases the Risk of an Alarming Cytological Outcome. J. Clin. Med., 10.","DOI":"10.3390\/jcm10040638"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1007\/s40618-019-01055-0","article-title":"Thyroid nodules with H\u00fcrthle cells: The malignancy risk in relation to the FNA outcome category","volume":"42","author":"Sporny","year":"2019","journal-title":"J. Endocrinol. Investig."},{"key":"ref_19","first-page":"53","article-title":"Association between Hashimoto\u2019s Thyroiditis and Thyroid Cancer in 64,628 Patients","volume":"10","year":"2017","journal-title":"Front. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1002\/cam4.997","article-title":"The impact of presence of Hashimoto\u2019s thyroiditis on diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy in subcentimeter thyroid nodules: A retrospective study from FUSCC","volume":"6","author":"Gao","year":"2017","journal-title":"Cancer Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"101367","DOI":"10.1016\/j.beem.2019.101367","article-title":"Hashimotos\u2019 thyroiditis: Epidemiology, pathogenesis, clinic and therapy","volume":"33","author":"Ragusa","year":"2019","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.autrev.2014.01.007","article-title":"Hashimoto thyroiditis: Clinical and diagnostic criteria","volume":"13","author":"Caturegli","year":"2014","journal-title":"Autoimmun. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1530\/EJE-19-0424","article-title":"Discordance of serological and sonographic markers for Hashimoto\u2019s thyroiditis with gold standard histopathology","volume":"181","author":"Guan","year":"2019","journal-title":"Eur. J. Endocrinol."},{"key":"ref_24","first-page":"34","article-title":"Guidelines of Polish National Societies Diagnostics and Treatment of Thyroid Carcinoma. 2018 Update","volume":"69","author":"Dedecjus","year":"2018","journal-title":"Endokrynol. Pol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1159\/000478927","article-title":"European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS","volume":"6","author":"Russ","year":"2017","journal-title":"Eur. Thyroid. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/s12020-021-02781-3","article-title":"Low reproducibility of equivocal categories of the Bethesda System for Reporting Thyroid Cytology makes the associated risk of malignancy specific to the diagnostic center","volume":"74","author":"Klencki","year":"2021","journal-title":"Endocrine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4103\/1742-6413.139725","article-title":"Diagnosis of atypia\/follicular lesion of undetermined significance: An institutional experience","volume":"11","author":"Wong","year":"2014","journal-title":"Cytojournal"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jss.2019.07.068","article-title":"Chronic Lymphocytic Thyroiditis May Lower Accuracy of AUS\/FLUS Cytopathology in Surgical Patients","volume":"245","author":"Mulder","year":"2020","journal-title":"J. Surg. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1089\/thy.2013.0317","article-title":"Malignancy rate in thyroid nodules classified as Bethesda category III (AUS\/FLUS)","volume":"24","author":"Ho","year":"2014","journal-title":"Thyroid"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1309\/AJCP4P2GCCDNHFMY","article-title":"Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations: Should repeated fna be the preferred initial approach?","volume":"135","author":"VanderLaan","year":"2011","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1007\/s00268-013-2330-0","article-title":"Utilization and impact of repeat biopsy for follicular lesion\/atypia of undetermined significance","volume":"38","author":"Broome","year":"2014","journal-title":"World J. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Yoo, M.R., Gweon, H.M., Park, A.Y., Cho, K.E., Kim, J.A., Youk, J.H., and Son, E.J. (2015). Repeat Diagnoses of Bethesda Category III Thyroid Nodules: What to Do Next?. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0130138"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1089\/thy.2013.0650","article-title":"Thyroid nodules with atypia or follicular lesions of undetermined significance (Bethesda Category III): Importance of ultrasonography and cytological subcategory","volume":"24","author":"Rosario","year":"2014","journal-title":"Thyroid"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1002\/dc.21790","article-title":"Thyroid follicular lesion of undetermined significance: Evaluation of the risk of malignancy using the two-tier sub-classification","volume":"40","author":"Horne","year":"2012","journal-title":"Diagn. Cytopathol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1089\/thy.2012.0635","article-title":"Differences in risk of malignancy and management recommendations in subcategories of thyroid nodules with atypia of undetermined significance or follicular lesion of undetermined significance: The role of ultrasound-guided core-needle biopsy","volume":"24","author":"Choi","year":"2014","journal-title":"Thyroid"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1089\/105072501750159714","article-title":"Thyroid cytology and the risk of malignancy in thyroid nodules: Importance of nuclear atypia in indeterminate specimens","volume":"11","author":"Kelman","year":"2001","journal-title":"Thyroid"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1159\/000333232","article-title":"Spectrum of risk of malignancy in subcategories of \u2018atypia of undetermined significance\u2019","volume":"55","author":"Olson","year":"2011","journal-title":"Acta Cytol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"745395","DOI":"10.3389\/fendo.2021.745395","article-title":"Malignancy Rate of Bethesda Class III Thyroid Nodules Based on the Presence of Chronic Lymphocytic Thyroiditis in Surgical Patients","volume":"12","author":"Cho","year":"2021","journal-title":"Front. Endocrinol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1530\/EJE-21-0094","article-title":"The diagnostic accuracy of fine-needle aspiration cytology for thyroid nodules is not affected by coexistent chronic autoimmune thyroiditis: Results from a cyto-histological series of patients with indeterminate cytology","volume":"185","author":"Rotondi","year":"2021","journal-title":"Eur. J. Endocrinol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1007\/s12020-020-02300-w","article-title":"Strategy to reduce unnecessary surgeries in thyroid nodules with cytology of Bethesda category III (AUS\/FLUS): A retrospective analysis of 667 patients diagnosed by surgery","volume":"69","author":"Suh","year":"2020","journal-title":"Endocrine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1159\/000504705","article-title":"Can Repeat Biopsies Change the Prognoses of AUS\/FLUS Nodule?","volume":"9","author":"Aydin","year":"2020","journal-title":"Eur. Thyroid. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1007\/s12020-016-0982-x","article-title":"Malignancy is associated with microcalcification and higher AP\/T ratio in ultrasonography, but not with Hashimoto\u2019s thyroiditis in histopathology in patients with thyroid nodules evaluated as Bethesda Category III (AUS\/FLUS) in cytology","volume":"54","author":"Topaloglu","year":"2016","journal-title":"Endocrine"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"686849","DOI":"10.3389\/fendo.2021.686849","article-title":"Surgical Outcome and Malignant Risk Factors in Patients with Thyroid Nodule Classified as Bethesda Category III","volume":"12","author":"Huang","year":"2021","journal-title":"Front. Endocrinol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1002\/cncy.21468","article-title":"The impact of atypia\/follicular lesion of undetermined significance and repeat fine-needle aspiration: 5 years before and after implementation of the Bethesda System","volume":"122","author":"Sullivan","year":"2014","journal-title":"Cancer Cytopathol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1002\/dc.23456","article-title":"Malignancy rate associated with Bethesda category III (AUS\/FLUS) with and without repeat fine needle aspiration biopsy","volume":"44","author":"Kuru","year":"2016","journal-title":"Diagn. Cytopathol."},{"key":"ref_46","first-page":"4521984","article-title":"Malignancy Risk and Related Factors of Atypia of Undetermined Significance\/Follicular Lesion of Undetermined Significance in Thyroid Fine Needle Aspiration","volume":"30","author":"Hong","year":"2018","journal-title":"Int. J. Endocrinol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Kaliszewski, K., Diakowska, D., Rzeszutko, M., Nowak, \u0141., Tokarczyk, U., and Rudnicki, J. (2021). Atypia and Follicular Lesions of Undetermined Significance in Subsequent Biopsy Result: What Clinicians Need to Know. J. Clin. Med., 10.","DOI":"10.3390\/jcm10143082"},{"key":"ref_48","first-page":"491","article-title":"Which factors are associated with malignancy in thyroid nodules classified as bethesda category 3 (AUS\/FLUS) and how do they influence the patient\u2019s management?","volume":"15","author":"Kaya","year":"2019","journal-title":"Acta Endocrinol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2601","DOI":"10.1007\/s00330-015-3668-5","article-title":"Malignancy risk and characteristics of thyroid nodules with two consecutive results of atypia of undetermined significance or follicular lesion of undetermined significance on cytology","volume":"25","author":"Park","year":"2015","journal-title":"Eur. Radiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1245\/s10434-013-2990-x","article-title":"Thyroid Nodules with Bethesda System III Cytology: Can Ultrasonography Guide the Next Step?","volume":"20","author":"Gweon","year":"2013","journal-title":"Ann. Surg. Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"S\u0142owi\u0144ska-Klencka, D., Klencki, M., Wojtaszek-Nowicka, M., Wysocka-Konieczna, K., Wo\u017aniak-Ose\u0142a, E., and Popowicz, B. (2021). Validation of Four Thyroid Ultrasound Risk Stratification Systems in Patients with Hashimoto\u2019s Thyroiditis; Impact of Changes in the Threshold for Nodule\u2019s Shape Criterion. Cancers, 13.","DOI":"10.3390\/cancers13194900"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/8\/1971\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:53:30Z","timestamp":1760136810000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/8\/1971"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,13]]},"references-count":51,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["cancers14081971"],"URL":"https:\/\/doi.org\/10.3390\/cancers14081971","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,13]]}}}