Reliability of Ultrasound Features in Predicting Thyroid Malignancy

The predefined rule using ≥2 features showed high sensitivity for detecting malignant thyroid nodules, making it useful for screening. The presence of irregular margins and microcalcifications (M + C pair) provided a more balanced sensitivity-specificity trade-off, supporting its use for risk stratification rather than direct surgical decision-making. While these ultrasound criteria show strong diagnostic performance, definitive management decisions should continue to rely on multidisciplinary assessment, integrating cytology, clinical findings, and patient factors. Further prospective validation in larger, unselected cohorts is recommended to refine threshold criteria and confirm generalizability.