ArticleClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2026
Unmasking risk in low-suspicion thyroid nodules: clinical and sonographic predictors of malignancy in TIRADS 3, a retrospective single-center study.
Article in Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThyroid nodules categorized as TIRADS 3 are typically considered low risk for malignancy (estimated < 5%) under the 2017 ACR TI-RADS guidelines. However, the real-world application of these criteria may vary, with many TIRADS 3 nodules undergoing fine-needle aspiration (FNA) despite recommendations for surveillance. This study aimed to identify clinical and ultrasonographic predictors of malignancy in TIRADS 3 nodules to enhance risk stratification.
methodsThis retrospective, single-center study included 200 patients aged 18-65 years with ultrasound-confirmed TIRADS 3 thyroid nodules who underwent FNA between January 2021 and December 2022. Although ACR guidelines recommend biopsy for nodules ≥ 2.5 cm, FNA was also performed in smaller nodules presenting with high-risk features such as capsule bulging or central-peripheral vascularity. Data were collected from anonymized hospital records. Multivariate logistic regression was used to identify independent predictors of malignancy.
resultsThe malignancy rate was 20%, exceeding the expected threshold for TIRADS 3 nodules. Capsule expansion (OR 18.50, p < 0.001), central-peripheral vascularity (OR 4.99, p = 0.004), and a family history of thyroid cancer (OR 13.08, p = 0.001) were identified as significant predictors. All malignancy diagnoses were based on cytological findings (Bethesda V/VI), with no histopathologic confirmation available.
conclusionCertain TIRADS 3 nodules may possess a higher malignancy risk than traditionally assumed. Incorporating additional ultrasound features and clinical context may improve diagnostic accuracy. Future prospective studies with histopathological confirmation are warranted to validate these predictors.
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