ACCURACY OF THE BETHESDA SCORING SYSTEM IN PREDICTING HISTOPATHOLOGICAL OUTCOMES

Background: The Bethesda system for reporting thyroid cytopathology (TBSRTC) classified thyroid nodules into sex categories, each with an associated risk of malignancy. It provided an approach for evaluating fine needle aspiration cytology and guiding clinical decisions. However, its predictive accuracy varied across populations. Many studies examined how well Bethesda classifications align with final histopathological findings to assess its effectiveness in distinguishing between benign and malignant thyroid lesions. Objective: This study aimed to assess the accuracy of the Bethesda system in predicting the final histopathological diagnosis of thyroid nodules. Methodology: We conducted an observational, retrospective, single center study at the Princess Haya Military Hospital in Ajloun, Jordan between 2023/2024 on patients who underwent thyroid FNA cytology followed by surgical excision and histopathological evaluation. Data were collected for demographic information like age, gender. Clinical characteristics such as Bethesda classification results, histopathological findings, and associated medical history such as comorbidities (diabetes mellitus, hypertension, and hypothyroidism) were analyzed. Statistical analyses were performed using R studio (version 2024.09.0) Vienna, Austria. Results: Our study analyzed 99 cases with a mean age of 46.97 years, 89.9% of whom were female. Common comorbidities included diabetes (15.15%), hypertension (18.18%), and hypothyroidism (8.08%). Fine-needle aspiration (FNA) findings classified 27.2% of cases as benign, 27.2% as malignant, and 36.3% as indeterminate. The most frequent Bethesda category was III (37.76%), followed by II (25.51%) and IV (16.33%). Histopathology confirmed 53.5% as benign and 41.41% as malignant, with papillary carcinoma being the most common (36.36%). Surgery was performed in 81.81% of cases. Statistical analysis showed malignancy was exclusive to Bethesda categories V and VI (100%), with category IV at 75% and category III at 40.54%. Logistic regression identified lesion size as a significant predictor of malignancy (OR = 1.24, p = 0.01), while hypertension and diabetes showed possible associations but were not statistically significant. Conclusion: Our study demonstrated that the Bethesda system effectively predicted thyroid malignancy, with high specificity but moderate sensitivity. Malignancy was exclusive to Bethesda categories V and VI. Lesion size was an important predictor.