Association between Bethesda Categories and Ultrasound Features of Conventional Papillary Thyroid Carcinoma

The association between categories 3, 5 and 6 of the Bethesda System for Reporting Thyroid Cytopathology and the clinical and ultrasonography (US) features of conventional papillary thyroid carcinoma (PTC) was evaluated. We included 2005 patients diagnosed with conventional PTC at surgery and Bethesda categories 3, 5 and 6 at pre-operative US-guided fine-needle aspiration. Multinomial regression analysis was performed to determine the odds ratio (ORs) of each US feature associated with category 3 or 5, with category 6 as reference. Category 3 and 5 PTCs were smaller (ORs = 0.925 and 0.937) and did not exhibit marked hypo-echogenicity (ORs = 0.341 and 0.268) compared with category 6 PTCs. Category 3 and 5 PTCs exhibited significant macrocalcification (ORs = 2.372 and 1.594) and heterogeneous parenchyma (OR = 1.265 in category 5). In conclusion, conventional PTCs pre-operatively aspirated as Bethesda category 3, 5 or 6 significantly differ in size, macrocalcification, underlying thyroid parenchymal echogenicity and final assessment of US features.