Indeterminate Bethesda System Category (Bethesda Category III) Thyroid Nodules: Cytomorphologic…

Cohort studyActa cytologica· Jun 2026

Indeterminate Bethesda System Category (Bethesda Category III) Thyroid Nodules: Cytomorphologic Subclassification and Its Impact on Malignancy Risk.

Rinë Limani, Zgjim Limani, Shkelzen Reçica … Drita Miftari Pazhari

Head & Neck & Endocrine PathologyCohort studyDiagnosisQ3IF 1.2

Nuclear atypia subtype carries the highest malignancy rate among indeterminate thyroid nodules.

Indeterminate Bethesda System Category (Bethesda Category III) Thyroid Nodules: Cytomorphologic Subclassification and Its Impact on Malignancy Risk.

Rinë Limani … Drita Miftari Pazhari

Acta cytologica · Jun 2026 · Q3 in Pathology

Background

Bethesda category III thyroid cytology (atypia of undetermined significance [AUS]) represents a diagnostically diverse category with variable malignancy risk.

Methods

We performed a retrospective study of Bethesda category III thyroid nodules from a tertiary-care center.

n = 186 cases

Results

nuclear atypia nodules were malignant more often than any other subtype

OR 4.52 (95% CI 1.94 to 10.54)

null 1

1.94

10.54

CI excludes the null - significant

More results

Architectural atypia was the most common subtype (44.4%), followed by nuclear atypia (29.2%), cystic/inflammatory atypia (14.9%), and oncocytic atypia (11.5%).

Malignancy was identified in 41.9% of definitively linked cases.

Papillary thyroid carcinoma was the predominant malignant diagnosis.

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Conclusion · 1 of 3

Cytomorphologic subclassification of Bethesda category III (AUS) thyroid nodules identifies nuclear atypia as the strongest predictor of malignancy.

Conclusion · 2 of 3

Incorporation of cytomorphologic subclassification into routine reporting may improve risk stratification and clinical decision-making in Bethesda category III nodules.

Conclusion · 3 of 3

Malignancy rates varied substantially according to denominator definition, highlighting the impact of case selection on risk estimation.

Indeterminate Bethesda System Category (Bethesda Category III) Thyroid Nodules: Cytomorphologic Subclassification and Its Impact on Malignancy Risk.

Indeterminate Bethesda System Category (Bethesda Category III) Thyroid Nodules: Cytomorphologic Subclassification and Its Impact on Malignancy Risk.

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