ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Thyroid Endocrinology
The Clinical Value of Repeat Ultrasound-Guided Fine-Needle Aspiration Biopsy in the Management of Bethesda Category III Thyroid Nodules
Provisionally accepted
- Jilin University, Changchun, China
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Methods: We retrospectively analyzed the clinical data of 109 patients (114 nodules) who underwent rFNAB at our hospital from December 2020 to December 2025, including 87 females and 22 males. Based on rFNAB results, the nodules were divided into a definitive diagnosis group (93 nodules) and a non-definitive diagnosis group (21 nodules). The definitive diagnosis group was further subdivided into a malignant group (62 nodules, Bethesda V/VI) and a benign group (31 nodules, Bethesda II). We recorded biopsy results, intervals between biopsies, postoperative pathological findings, and ultrasonographic features. Statistical differences between groups were analyzed. Statistical methods included the χ² test, Fisher’s exact test, binary logistic regression analysis, and ROC curve analysis. Results: Among the 114 Bethesda Category III nodules, 93 (81.6%) obtained a definitive diagnosis through rFNAB, including 62 malignant (66.7%) and 31 benign (33.3%) nodules; 21 nodules (18.4%) remained non-diagnostic. Forty-seven patients with malignant rFNAB results underwent surgical treatment, including 9 (19.1%) in the <3-month interval group and 38 (80.9%) in the ≥3-month interval group. No significant differences were observed in lymph node metastasis rates or recurrence risk stratification between the two groups. Among the ultrasonographic characteristics of the malignant, benign, and non-diagnostic groups, only calcification type showed a statistically significant difference (P < 0.05). Additionally, ROC curve analysis confirmed the diagnostic efficacy of the TI-RADS score for Bethesda Category III nodules (AUC = 0.746). The maximum Youden index (0.403) was achieved at a cut-off value of 8 points (specificity 83.9%, sensitivity 56.5%). Conclusion: Repeat fine-needle aspiration biopsy (rFNAB) significantly improves the diagnostic rate for thyroid nodules initially diagnosed as Bethesda Category III, and the time interval between the two biopsies does not affect diagnostic performance. For the follow-up of nodules with an initial Bethesda Category III FNAB result, rFNAB is recommended when the TI-RADS score is ≥8, especially if suspicious ultrasonographic signs such as new or persistent microcalcifications are present. During the procedure, multi-point sampling should target non-calcified areas at the nodule periphery to improve the accuracy and reliability of rFNAB.
Keywords: ACR TI-RADS5, bethesda Category III4, fine-needle aspiration cytology2, repeat fine-needle aspiration biopsy3, Thyroid nodule1
Received: 20 Nov 2025; Accepted: 12 Feb 2026.
Copyright: © 2026 Chen, Fu, He, Guo, Zhang, Sun, Zhou and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chong Chen
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