Prediction of malignancy of thyroid nodules

Cytopuncture is the gold standard for the evaluation of malignancy of thyroid nodules. Nodules of intermediate cytology, because of their variable risk, represent a challenge in their management. The main objective of our study is to evaluate the contribution of ultrasound in addition to cytopuncture in the prediction of malignancy of intermediate cytology nodules classified as Bethesda 3 or 4 in order to propose a new classification to improve their therapeutic management. Our BeTIR classification allows a different approach in the management of Bethesda 3 and 4 nodules with a better sensitivity and specificity in the prediction of malignancy. Based on our results, we consider that Bethesda 3/TIRADS 4B and 5 nodules should benefit from surgical removal while Bethesda 4/TIRADS 2 and 3 nodules may benefit from surveillance.