PT  - JOURNAL ARTICLE
AU  - Alwadi, Fahad
AU  - Alessa, Mohammed
AU  - Abdulkarim Alamer, Elaf
AU  - Alrabiah, Hamad F.
AU  - Alaraifi, Abdulaziz
AU  - Alsalem, Abdulaziz
AU  - Mohamed Pharaon, Majed
AU  - Khalid Alhabib, Rahaf
TI  - Risk of malignancy in thyroid nodules Bethesda III sub classification into nuclear atypia and architectural atypia. <em>A retrospective study</em>
AID  - 10.15537/smj.2025.46.4.202040805
DP  - 2025 Apr 01
TA  - Saudi Medical Journal
PG  - 425--428
VI  - 46
IP  - 4
4099  - http://smj.org.sa/content/46/4/425.short
4100  - http://smj.org.sa/content/46/4/425.full
SO  - Saudi Med J2025 Apr 01; 46
AB  - Objectives: To identify the risk of malignancy in the Bethesda III category based on histopathological subclassification.Methods: We retrospectively analyzed 193 patients with Bethesda III thyroid nodules who underwent surgical resection. The primary outcome was the malignancy risk associated with each histopathological sub-classification.Results: Of 193 patients, final histopathology revealed malignant nodules in 96 (49.7%). The malignancy rates varied among the Bethesda III subcategories, with Hürthle cell atypia of undetermined significance demonstrating the highest rate (55.6%), followed by cytological atypia (55.4%), architectural atypia (50.6%), and combined cytological and architectural atypia (33.3%). However, no significant difference in malignancy rates was observed among the Bethesda III subcategories (p=0.240). Papillary thyroid carcinoma was the most common malignant tumor in all Bethesda III subcategories.Conclusion: Bethesda III nodules pose a clinical challenge. Our findings indicate a higher risk of malignancy in patients with cytologic atypia. Bethesda III subclassification may improve clinical decisions and interdisciplinary communication