Integrating TBSRTC subcategorization and BRAF V600E testing for precision management of Bethesda III thyroid nodules: a WHO 5th edition-based study highlighting subtype-specific diagnostic disparities

In Bethesda III nodules, a diameter <1 cm or the "with nuclear atypia" subcategory indicates a high malignant risk (OR = 121.854), warranting active management. Preoperative <i>BRAF</i> V600E testing provides excellent detection for classical PTC (sensitivity 90.2%, specificity 100%) but exhibits limited sensitivity for FVPTC (40%). Based on the 3rd edition TBSRTC and 5th edition WHO classification, our risk-stratified algorithm could reduce unnecessary surgeries by 25-30% in indeterminate nodules while maintaining perfect specificity for classical PTC, achieving optimal clinical decision-making.