Abstract

Thyroid nodules are focal, well-defined areas of altered echogenicity within the thyroid gland, detected in 4–8% of the population by palpation and 19–67% by ultrasonography. In India, their prevalence is approximately 8.5%. Although most nodules are benign, 5–15% may be malignant, necessitating accurate evaluation. High-resolution ultrasonography (USG) with the Thyroid Imaging Reporting and Data System (TIRADS) and fine needle aspiration cytology (FNAC) reported using the Bethesda system are widely employed diagnostic tools. This study aimed to compare TIRADS scoring with Bethesda classification, assess their correlation, and evaluate whether their combined use improves malignancy detection. A total of 90 patients with solitary thyroid nodules were evaluated using both TIRADS and Bethesda scoring systems. The majority of patients were aged 51–60 years (36.67%) and were female (86.67%). Bethesda Category II constituted the largest group (55.56%), while most nodules were classified as TIRADS Category 3 (45.56%). A statistically significant positive correlation was observed between TIRADS and Bethesda scores (r = 0.3256, p = 0.0017). Logistic regression analysis demonstrated significant associations between each scoring system and histopathological outcomes, with pseudo-R² values of 0.13 for TIRADS and 0.44 for Bethesda. Notably, combining TIRADS and Bethesda scores improved predictive performance, yielding a higher pseudo-R² value of 0.55. The combined use of TIRADS and Bethesda classification enhances diagnostic accuracy for thyroid malignancy and optimizes clinical decision-making. However, larger multicentric studies are required to validate these findings and develop standardized diagnostic guidelines.

Key words: Bethesda classification, Risk stratification, Solitary thyroid nodule, Thyroid malignancy, TIRADS, Ultrasonography