Predictors of Malignancy and False‐Negative Risk in Large (≥ 3 cm) Thyroid Nodules: Insights From a Single‐Centre Thyroidectomy Cohort
Authors' conclusion
In this surgically selected cohort of large thyroid nodules, sonographic risk, suspicious LAP and clinical context outperformed size alone in predicting malignancy.
Study context
- Population
- Thyroidectomy patients (2018–2024) with a ≥ 3 cm dominant thyroid nodule
- Participants
- 285 patients
- Outcome
- Malignancy prevalence, predictors of malignancy and FN cytology among Bethesda II nodules
Methodological detailssingle-centre, surgical cohort, multivariable logistic regression with bootstrap validation
- Single-centre
- Surgical cohort
- Multivariable logistic regression with bootstrap validation
Main finding
As reported in the abstract
Malignancy proportion
- Observed malignancy proportion (38/285), predominantly papillary carcinoma
- 13.3%
- Independent predictor: EU-TIRADS TR4-5
- OR 7.6
- Independent predictor: suspicious lymphadenopathy (LAP)
- OR 6.0
- Size ≥ 4 cm (smaller effect)
- OR 2.6
- Solid composition (smaller effect)
- OR 3.3
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Postoperative malignancy (FN) among Bethesda II cases≥ 4 cm vs < 4 cm · 7.5% vs. 0% | P = 0.023 |
- Postoperative malignancy (false-negative (FN)) among Bethesda II cases — Malignancy among 111 Bethesda II cases: five, all in ≥ 4 cm nodules
- 4.5%
- Postoperative malignancy (FN) among Bethesda II cases — Nodule size association with FN probability
- AUC 0.75
- Postoperative malignancy (FN) among Bethesda II cases: Post hoc review suggested cystic/infiltrative features potentially contributing to sampling limitations
Original publication
Predictors of Malignancy and False‐Negative Risk in Large (≥ 3 cm) Thyroid Nodules: Insights From a Single‐Centre Thyroidectomy Cohort. Clin Endocrinol (Oxf). Published 29 July 2026. doi:10.
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