Thyroid nodules and the risk of cancer based on fine-needle aspiration using Bethesda classification in Riyadh, Saudi Arabia

Abstract

Background: The presence of thyroid nodules is common and can only be diagnosed through radiographic examination. Fine needle aspiration is an essential technique to identify the type of nodules and their malignancy categorization. This study aims to evaluate the effectiveness of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) method in the Security Force Hospital, Riyadh, Saudi Arabia, and to estimate the frequency of Bethesda categorization in reporting fine needle aspiration sampling and predicting the malignancy risk in Riyadh. Methods: This is a retrospective chart review that included records of patients with sonographic thyroid nodules and an indicator for fine needle aspiration based on the American Thyroid Association guideline recommendations. The results of FNA were then classified based on the Bethesda system. Data analysis was executed through the Statistical Package for the Social Sciences (SPSS) version 26. Results: This study included 519 patients over three years. The average age was 49.71±12.4. 74.4% were asymptomatic, 50.7% had a thyroid nodule, while 33.9% had a multinodular goiter. 30.6% of the nodules had a size between 1 to 1.49 cm. 42% had smooth borders. The nodules most commonly had a low suspicion of malignancy by sonography, and 22.7% of the patients underwent thyroid surgery; of them, 54.2% had malignancy. Higher Bethesda classes and a sonographic pattern of intermediate suspicion were common predictors associated with a significantly higher risk of malignancy (p-value < 0.001). Conclusion: Thyroid malignancy is commonly detected by thyroid surgery; the use of Bethesda classification is a predictor of thyroid malignancy, and its application in Saudi hospitals should be improved.