A Bethesda System for Reporting Thyroid Cytopathology category IV diagnosis, often referred to as “suspicious for follicular neoplasm” or “follicular lesion of undetermined significance,” indicates that the cells collected during the fine-needle aspiration biopsy exhibit some atypical features, but not enough to definitively diagnose cancer. These abnormalities might include variations in cell size and shape, or architectural changes within the follicle structures. Distinguishing between benign and malignant follicular tumors based solely on cytology is often challenging, making further investigation crucial.
This diagnostic category plays a vital role in patient care because it flags the potential presence of malignancy, prompting further evaluation. Historically, before the widespread adoption of the Bethesda System, diagnostic terminology lacked standardization, leading to potential inconsistencies in interpretation and management. The Bethesda System, with its clearly defined categories, improved communication among clinicians and pathologists, resulting in more consistent and evidence-based treatment plans. A category IV designation specifically allows for risk stratification and guides clinicians toward appropriate next steps, such as molecular testing or surgical excision, to definitively determine the presence or absence of thyroid cancer.
The subsequent sections will delve into the diagnostic procedures following a category IV result, explore available molecular testing options, discuss surgical considerations, and outline post-surgical management strategies.
1. Follicular Neoplasm
Follicular neoplasm represents a key diagnostic challenge within the context of thyroid cytology. A Bethesda System for Reporting Thyroid Cytopathology category IV designation, often signifying “suspicious for follicular neoplasm,” underscores the inability to distinguish benign follicular adenomas from malignant follicular carcinomas based solely on fine-needle aspiration biopsy. This diagnostic uncertainty arises because both benign and malignant follicular tumors share similar cellular characteristics, making definitive diagnosis through cytology alone impossible. The designation signifies the presence of follicular cells exhibiting some atypical features, but not enough to definitively classify the lesion as cancerous. This presents a critical juncture in patient management, as it necessitates further investigation to determine the true nature of the neoplasm. For instance, a patient with a predominantly follicular pattern on biopsy, lacking clear signs of malignancy, might receive a Bethesda IV classification, highlighting the need for additional diagnostic procedures.
The practical significance of understanding the association between follicular neoplasm and a Bethesda IV diagnosis lies in its implications for subsequent management. A Bethesda IV result triggers further diagnostic workup, including molecular testing and/or surgical excision. Molecular tests can analyze specific genetic markers associated with follicular carcinomas, helping to stratify risk and guide treatment decisions. Surgical excision, typically a lobectomy or total thyroidectomy, provides tissue for comprehensive histopathological examination, the gold standard for differentiating benign and malignant follicular tumors. This allows for accurate diagnosis and guides definitive treatment planning, ranging from observation for benign lesions to radioactive iodine therapy for malignant cases. The potential for a Bethesda IV diagnosis to represent either a benign adenoma or a follicular carcinoma highlights the need for a thorough and individualized approach to patient care.
In summary, a Bethesda IV diagnosis signifying “suspicious for follicular neoplasm” indicates diagnostic uncertainty within the context of thyroid cytology. The inability to differentiate benign from malignant follicular tumors based solely on cytology necessitates further investigation, including molecular testing and/or surgical excision. This understanding enables appropriate risk stratification and guides evidence-based management decisions, ensuring patients receive optimal and individualized care. Addressing this diagnostic challenge through further workup is crucial for accurate diagnosis and effective treatment planning.
2. Diagnostic Uncertainty
Diagnostic uncertainty is inherent in a Bethesda category IV thyroid biopsy result, signifying “suspicious for follicular neoplasm” or “follicular lesion of undetermined significance.” This uncertainty stems from the limitations of cytology in definitively differentiating between benign and malignant follicular lesions. A category IV designation signifies that the sampled cells exhibit some atypical features concerning for malignancy but lack definitive characteristics of thyroid cancer. This ambiguity necessitates further investigation to achieve a conclusive diagnosis and guide appropriate management.
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Cytological Ambiguity
The cytological features observed in Bethesda IV cases often overlap between benign follicular adenomas and well-differentiated follicular carcinomas. Cellular features like nuclear enlargement, crowding, and overlapping can be present in both benign and malignant lesions, making it difficult to distinguish them solely based on microscopic examination of the aspirated cells. For example, a follicular adenoma exhibiting cellular atypia might be indistinguishable from a well-differentiated follicular carcinoma on fine-needle aspiration cytology, leading to a category IV classification.
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Limitations of Fine-Needle Aspiration Biopsy
While fine-needle aspiration biopsy is a valuable diagnostic tool, it has limitations in the context of follicular lesions. The procedure samples only a small portion of the nodule, potentially missing areas of malignancy within a predominantly benign lesion. Furthermore, architectural features, crucial for distinguishing between benign and malignant follicular neoplasms, are not always readily apparent on cytology. This limitation necessitates additional diagnostic procedures to overcome the inherent uncertainty of a Bethesda IV result.
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Need for Molecular Testing
The diagnostic uncertainty associated with Bethesda IV often necessitates molecular testing. These tests analyze specific genetic markers associated with thyroid cancer, helping to stratify risk and guide management decisions. For instance, mutations in genes like BRAF and RAS increase the suspicion for malignancy, whereas a negative molecular panel can be reassuring, although it does not definitively exclude cancer. Molecular testing aids in refining the diagnostic process but may not always provide conclusive answers.
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Role of Surgical Excision
Surgical excision, such as a lobectomy or total thyroidectomy, plays a critical role in resolving the diagnostic uncertainty of a Bethesda IV result. Histopathological examination of the entire excised nodule provides a comprehensive assessment of cellular architecture and other features not readily apparent on cytology. This allows for definitive diagnosis, differentiating between benign adenomas and follicular carcinomas and guiding subsequent treatment decisions.
The diagnostic uncertainty associated with a Bethesda IV thyroid biopsy result highlights the complexity of managing follicular lesions. The limitations of cytology, the need for molecular testing, and the crucial role of surgical excision in achieving a definitive diagnosis underscore the importance of a multidisciplinary approach to patient care. By integrating clinical, cytological, molecular, and histopathological findings, clinicians can effectively navigate the diagnostic uncertainty and provide individualized, evidence-based treatment strategies. This comprehensive approach optimizes patient outcomes and minimizes the potential risks associated with both undertreatment and overtreatment of thyroid nodules.
3. Further Investigation
A Bethesda category IV thyroid biopsy result, indicating “suspicious for follicular neoplasm” or “follicular lesion of undetermined significance,” necessitates further investigation due to the inherent diagnostic uncertainty associated with this classification. The inability to definitively differentiate between benign and malignant follicular lesions based solely on cytology mandates additional diagnostic procedures to guide appropriate management decisions. This further investigation may involve molecular testing, surgical excision, or a combination of both. The specific approach depends on individual patient factors, including clinical presentation, cytological features, and patient preferences.
Molecular testing analyzes specific genetic alterations within the thyroid nodule. Certain genetic markers, such as BRAF and RAS mutations, are associated with increased risk of malignancy. While a positive molecular test elevates suspicion for cancer, it does not definitively confirm its presence. Conversely, a negative molecular test, while reassuring, does not entirely exclude the possibility of malignancy. Molecular testing provides valuable risk stratification information, aiding clinicians in determining the most appropriate next steps. For example, a patient with a Bethesda IV result and a positive BRAF mutation might be recommended for surgical excision due to the elevated likelihood of malignancy.
Surgical excision, typically a lobectomy or total thyroidectomy, provides tissue for comprehensive histopathological examination. This represents the gold standard for differentiating benign follicular adenomas from malignant follicular carcinomas. Histopathological evaluation assesses architectural features, including capsular and vascular invasion, which are critical for accurate diagnosis and not readily apparent on cytology. Surgical excision not only resolves diagnostic uncertainty but also serves as the primary treatment modality for malignant follicular neoplasms. Following surgical excision, patients might require additional therapy, such as radioactive iodine, depending on the final histopathological diagnosis and staging.
The practical significance of further investigation following a Bethesda IV diagnosis lies in its capacity to resolve diagnostic uncertainty, guide personalized treatment strategies, and optimize patient outcomes. By integrating clinical, cytological, molecular, and histopathological findings, clinicians can tailor management plans, minimizing the potential risks of both undertreatment and overtreatment. This comprehensive approach ensures that patients with benign follicular lesions avoid unnecessary aggressive interventions, while those with malignant tumors receive timely and appropriate treatment. Addressing the diagnostic challenge posed by Bethesda IV through further investigation is paramount for delivering evidence-based, patient-centered care.
4. Molecular Testing
Molecular testing plays a crucial role in the evaluation of Bethesda category IV thyroid biopsy results, designated as “suspicious for follicular neoplasm” or “follicular lesion of undetermined significance.” This diagnostic category represents a gray zone where cytology alone cannot definitively distinguish between benign and malignant follicular lesions. Molecular analysis helps refine this diagnostic uncertainty by assessing for specific genetic alterations associated with thyroid cancer, providing valuable information for risk stratification and guiding subsequent management decisions. The utilization of molecular testing reflects the evolving landscape of thyroid cancer diagnostics, moving beyond traditional morphological assessment towards a more personalized and precise approach.
Several specific gene mutations are commonly evaluated in the context of Bethesda category IV thyroid nodules. Mutations in the BRAF gene, particularly the V600E mutation, are strongly associated with papillary thyroid carcinoma and, when found in a follicular-patterned nodule, suggest a higher likelihood of malignancy. RAS mutations, encompassing alterations in NRAS, HRAS, and KRAS, are also implicated in thyroid cancer development and can contribute to risk stratification. Furthermore, gene fusions, such as PAX8/PPAR, though less common than BRAF or RAS mutations, can indicate a follicular variant of papillary thyroid carcinoma. The presence or absence of these genetic alterations helps refine the probability of malignancy, guiding decisions regarding surgical intervention and the extent of surgery. For instance, a Bethesda IV nodule harboring a BRAF V600E mutation might favor a more aggressive surgical approach compared to a nodule with a negative molecular profile.
The practical significance of molecular testing in Bethesda IV cases lies in its ability to personalize patient care. By providing a more precise risk assessment, molecular analysis can avoid unnecessary surgeries for patients with benign lesions while ensuring timely intervention for those with a higher likelihood of malignancy. This targeted approach reduces potential morbidity associated with unnecessary procedures and improves the overall management of indeterminate thyroid nodules. However, it is crucial to acknowledge that molecular testing is not a standalone diagnostic tool. Results must be interpreted in conjunction with clinical findings, cytological features, and ultimately, histopathological examination following surgical excision when indicated. The integration of these various diagnostic modalities ensures a comprehensive and individualized approach to patient care in the face of diagnostic uncertainty inherent in Bethesda category IV thyroid biopsy results. Challenges remain in standardizing molecular testing protocols and interpreting results in the context of evolving genomic understanding, highlighting the ongoing need for research and refinement in this field.
5. Surgical Excision
Surgical excision plays a pivotal role in the management of Bethesda category IV thyroid nodules, designated as “suspicious for follicular neoplasm” or “follicular lesion of undetermined significance.” This diagnostic category signifies a level of uncertainty where cytology alone cannot definitively differentiate between benign and malignant follicular lesions. Surgical excision, typically involving a lobectomy (removal of one thyroid lobe) or total thyroidectomy (removal of the entire thyroid gland), becomes necessary to obtain sufficient tissue for a comprehensive histopathological evaluation, establishing a definitive diagnosis and guiding subsequent treatment strategies. The decision to proceed with surgical excision depends on several factors, including patient age, comorbidities, cytological features, molecular testing results, and sonographic characteristics of the nodule. While molecular testing can offer valuable insights into the likelihood of malignancy, it does not replace the need for histopathological confirmation in Bethesda IV cases. For instance, a patient with a Bethesda IV nodule demonstrating worrisome sonographic features, such as irregular margins or microcalcifications, might be recommended for surgical excision even in the absence of a positive molecular test.
Histopathological examination of the excised tissue allows for a thorough assessment of architectural features not readily apparent on cytology. These features include capsular invasion (spread of tumor cells beyond the nodule’s capsule) and vascular invasion (presence of tumor cells within blood vessels), both crucial indicators of malignancy. The presence of capsular or vascular invasion upgrades the diagnosis from a benign follicular adenoma to a follicular carcinoma, significantly impacting subsequent management. This differentiation has substantial implications for treatment, as follicular carcinomas, unlike benign adenomas, may require additional therapy, such as radioactive iodine, to eliminate any remaining microscopic cancerous cells and reduce the risk of recurrence. Conversely, a benign histopathological diagnosis following surgical excision can provide reassurance and avoid unnecessary long-term monitoring or further interventions. For example, a patient undergoing a lobectomy for a Bethesda IV nodule might receive a final diagnosis of follicular adenoma, obviating the need for further surgery or radioactive iodine treatment.
In summary, surgical excision represents a cornerstone in the management of Bethesda category IV thyroid nodules. It provides the definitive diagnosis by enabling comprehensive histopathological examination, which assesses key architectural features indicative of malignancy. This definitive diagnosis then guides personalized treatment strategies, ranging from observation for benign lesions to more aggressive interventions, such as radioactive iodine therapy, for malignant tumors. While molecular testing can aid in risk stratification, surgical excision remains the gold standard for resolving the diagnostic uncertainty inherent in Bethesda IV cases, ultimately optimizing patient outcomes and minimizing the potential risks of both undertreatment and overtreatment. The integration of clinical, cytological, molecular, and histopathological findings underscores the importance of a multidisciplinary approach in the management of these diagnostically challenging thyroid nodules.
6. Risk Stratification
Risk stratification is integral to the management of Bethesda category IV thyroid biopsies, designated “suspicious for follicular neoplasm” or “follicular lesion of undetermined significance.” This diagnostic category presents inherent ambiguity regarding the potential for malignancy. Risk stratification aims to clarify this ambiguity by integrating various data points to estimate the likelihood of a malignant diagnosis, thus guiding personalized management decisions and optimizing patient outcomes. This process moves beyond the limitations of cytology alone, incorporating clinical, molecular, and imaging findings to inform a more precise and individualized approach.
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Cytological Features
Specific cytological characteristics observed during the initial fine-needle aspiration biopsy contribute to risk stratification. Features such as marked cellular atypia, architectural disarray, and increased mitotic activity raise suspicion for malignancy, placing the nodule at a higher risk category. Conversely, nodules exhibiting minimal atypia and preserved follicular architecture are considered lower risk. While these cytological features are not definitive for diagnosing malignancy, they contribute valuable information to the overall risk assessment. For example, a Bethesda IV nodule with significant nuclear atypia and pleomorphism would be considered higher risk than one with minimal cytological atypia.
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Molecular Markers
Molecular testing provides crucial data for risk stratification in Bethesda IV cases. Specific genetic alterations, such as BRAF and RAS mutations, are associated with varying degrees of malignancy risk. The presence of a BRAF V600E mutation, for instance, significantly increases the likelihood of cancer, placing the nodule in a high-risk category. Conversely, a negative molecular panel, while reassuring, does not entirely exclude malignancy but contributes to a lower-risk profile. Molecular markers refine risk assessment beyond cytology alone, aiding in more informed decision-making. For example, a Bethesda IV nodule with a positive BRAF mutation might prompt consideration for a more extensive surgical approach.
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Sonographic Characteristics
Ultrasound imaging provides valuable information for risk stratification by assessing the nodule’s sonographic features. Characteristics such as irregular margins, microcalcifications, hypoechogenicity, and taller-than-wide shape are associated with increased malignancy risk. These sonographic findings, combined with cytological and molecular data, further refine risk assessment. For example, a Bethesda IV nodule with suspicious sonographic features might warrant surgical excision even if molecular testing is negative.
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Patient Factors
Patient-specific factors, including age, family history of thyroid cancer, and history of radiation exposure, contribute to overall risk stratification. Younger patients and those with a family history of thyroid cancer are generally considered higher risk. Similarly, a history of head and neck radiation exposure increases the likelihood of malignancy. These factors are considered alongside cytological, molecular, and sonographic findings to provide a comprehensive risk assessment. For example, a younger patient with a Bethesda IV nodule and a family history of thyroid cancer might be advised to undergo surgical excision despite having a negative molecular test and reassuring sonographic features.
By integrating these various facets, risk stratification provides a personalized approach to managing Bethesda category IV thyroid nodules. This process allows for more informed decisions regarding further investigation and treatment, balancing the potential benefits of early intervention with the risks of unnecessary procedures. This individualized approach ensures that patients receive the most appropriate level of care based on their unique risk profile, optimizing outcomes and minimizing potential morbidity. The ongoing refinement of risk stratification models, incorporating emerging molecular markers and improved imaging techniques, continues to enhance the precision and effectiveness of thyroid nodule management.
7. Bethesda System
The Bethesda System for Reporting Thyroid Cytopathology provides a standardized framework for classifying thyroid fine-needle aspiration (FNA) biopsy results. This system establishes six diagnostic categories, each associated with a specific risk of malignancy and recommended management approach. A Bethesda category IV designation, signifying “suspicious for follicular neoplasm” or “follicular lesion of undetermined significance,” represents a crucial link between the Bethesda System and the diagnostic challenges inherent in evaluating follicular-patterned thyroid nodules. Before the widespread adoption of the Bethesda System, diagnostic terminology lacked uniformity, leading to potential inconsistencies in interpretation and subsequent patient management. The Bethesda System addressed this challenge by providing standardized terminology and clear management guidelines for each diagnostic category. This standardization facilitates effective communication among clinicians, pathologists, and patients, ensuring consistent and evidence-based care. For example, a Bethesda IV diagnosis obtained at one institution carries the same implications and recommended management as a Bethesda IV diagnosis at another, promoting uniformity in clinical practice.
The Bethesda System categorizes thyroid FNA results based on specific cytological criteria, assisting in risk stratification and guiding further investigation. A Bethesda category IV diagnosis indicates that the sampled cells exhibit some atypical features, raising suspicion for a follicular neoplasm, but lack definitive characteristics of malignancy. This diagnostic uncertainty arises because distinguishing between benign follicular adenomas and malignant follicular carcinomas based solely on cytology is often challenging. The Bethesda System acknowledges this diagnostic dilemma and recommends further investigation, typically involving molecular testing and/or surgical excision, for Bethesda IV cases. This approach ensures that patients receive appropriate and timely management based on their individual risk profiles. For instance, a patient with a Bethesda IV result might undergo molecular testing to assess for genetic markers associated with thyroid cancer. If these markers are positive, the likelihood of malignancy increases, prompting consideration for surgical excision. Conversely, a negative molecular panel might favor a more conservative approach, such as close monitoring.
Understanding the role of the Bethesda System in classifying and managing thyroid nodules, particularly those designated as Bethesda category IV, is crucial for all healthcare professionals involved in thyroid cancer care. The Bethesda System provides a standardized framework for risk stratification, guiding appropriate diagnostic workup and treatment decisions. This systematic approach enhances diagnostic accuracy, facilitates communication among healthcare providers, and empowers patients with a clearer understanding of their diagnosis and management options. Continued refinement and validation of the Bethesda System, incorporating emerging molecular markers and diagnostic techniques, remain essential for optimizing the care of patients with thyroid nodules. The Bethesda System’s focus on standardized reporting and risk-based management represents a significant advancement in thyroid cytopathology, promoting consistent and evidence-based practice while fostering personalized patient care.
Frequently Asked Questions
This section addresses common questions regarding Bethesda category IV thyroid biopsy results. Understanding these frequently asked questions can help alleviate anxieties and facilitate informed discussions with healthcare providers.
Question 1: What does a Bethesda category IV diagnosis mean?
A Bethesda category IV diagnosis, often termed “suspicious for follicular neoplasm” or “follicular lesion of undetermined significance,” indicates that the cells obtained during fine-needle aspiration biopsy exhibit some atypical features but are insufficient for a definitive diagnosis of cancer. This designation necessitates further investigation.
Question 2: Does a Bethesda IV result mean cancer is present?
Not necessarily. A Bethesda IV result indicates indeterminate cytology. While it raises the possibility of malignancy, it does not confirm the presence of cancer. Further diagnostic procedures are required to establish a definitive diagnosis.
Question 3: What are the next steps after receiving a Bethesda IV diagnosis?
Following a Bethesda IV diagnosis, further investigation is crucial. This often involves molecular testing of the biopsied cells to assess for genetic markers associated with thyroid cancer. Surgical excision, such as a lobectomy or total thyroidectomy, may also be recommended to obtain tissue for definitive histopathological evaluation.
Question 4: What is the role of molecular testing in Bethesda IV cases?
Molecular testing analyzes specific genes within the thyroid nodule, helping to stratify risk. Certain genetic mutations, such as BRAF and RAS mutations, increase the likelihood of malignancy. While a positive molecular test elevates suspicion for cancer, a negative result does not definitively rule it out.
Question 5: Why is surgical excision sometimes necessary?
Surgical excision provides tissue for comprehensive histopathological examination, the gold standard for differentiating benign from malignant thyroid lesions. Histopathology assesses architectural features, such as capsular and vascular invasion, which are not readily apparent on cytology but are crucial for accurate diagnosis.
Question 6: What are the chances of malignancy with a Bethesda IV result?
The risk of malignancy associated with a Bethesda IV diagnosis varies, typically ranging from 15% to 30%. Individual risk depends on specific cytological and molecular findings, as well as patient characteristics. A healthcare provider can offer a more personalized risk assessment based on individual circumstances.
Open communication with healthcare providers is crucial following a Bethesda IV diagnosis. These professionals can provide individualized guidance, addressing specific concerns and facilitating informed decisions throughout the diagnostic process.
For further information regarding Bethesda category IV thyroid biopsy results, please consult with a healthcare professional or refer to reputable medical resources.
Tips for Navigating a Bethesda Category IV Thyroid Biopsy Result
A Bethesda category IV diagnosis, often referred to as “suspicious for follicular neoplasm,” requires careful consideration and proactive management. The following tips provide guidance for individuals navigating this diagnostic category.
Tip 1: Seek Specialized Expertise: Consulting with an endocrinologist specializing in thyroid disorders is crucial. Endocrinologists possess the expertise to interpret Bethesda category IV results within the context of individual patient circumstances, guiding appropriate diagnostic and treatment strategies. This specialized expertise ensures personalized and evidence-based care.
Tip 2: Understand Molecular Testing Options: Molecular testing can provide valuable insights into the likelihood of malignancy. Discuss available molecular tests with a healthcare provider to determine the most appropriate panel based on individual risk factors and cytological findings.
Tip 3: Consider a Second Opinion: Obtaining a second opinion from an experienced thyroid cytopathologist can provide additional reassurance and ensure accurate interpretation of the initial biopsy results. This is particularly important given the inherent diagnostic challenges associated with Bethesda category IV.
Tip 4: Discuss Surgical Options Thoroughly: If surgical excision is recommended, engage in detailed discussions with a surgeon specializing in thyroid surgery. Understanding the rationale, potential risks, and benefits of different surgical approaches (lobectomy versus total thyroidectomy) empowers informed decision-making.
Tip 5: Maintain Open Communication with Healthcare Providers: Clear and consistent communication with the healthcare team is essential throughout the diagnostic and treatment process. Addressing concerns promptly and seeking clarification when needed ensures a collaborative and patient-centered approach to care.
Tip 6: Gather Information from Reputable Sources: Supplementing information provided by healthcare providers with knowledge from reputable medical organizations and patient advocacy groups enhances understanding and empowers informed decision-making.
Tip 7: Prioritize Emotional Well-being: Receiving a Bethesda category IV diagnosis can be emotionally challenging. Seeking support from family, friends, or support groups can provide emotional resilience and facilitate coping during this time.
Navigating a Bethesda category IV diagnosis requires proactive engagement and informed decision-making. By following these tips, individuals can effectively manage the diagnostic process, ensuring optimal outcomes and minimizing potential anxieties.
The subsequent conclusion will summarize key takeaways and emphasize the importance of personalized care in the management of Bethesda category IV thyroid nodules.
Conclusion
A Bethesda System for Reporting Thyroid Cytopathology category IV designation represents a diagnostic challenge, signifying a follicular lesion of undetermined significance. This classification necessitates a comprehensive approach integrating clinical, cytological, molecular, and histopathological findings. The inability to definitively differentiate benign from malignant follicular neoplasms based solely on cytology underscores the importance of further investigation. Molecular testing aids in risk stratification, while surgical excision provides the definitive diagnosis through histopathological examination. The management of these indeterminate thyroid nodules requires a multidisciplinary approach involving endocrinologists, cytopathologists, surgeons, and other healthcare professionals. Standardized reporting through the Bethesda System ensures consistent and evidence-based practice, facilitating effective communication and informed decision-making.
The diagnostic uncertainty inherent in a Bethesda category IV result necessitates a commitment to ongoing research and refinement of diagnostic and therapeutic strategies. Continued advancements in molecular diagnostics and improved understanding of thyroid cancer biology promise to further refine risk stratification and personalize treatment approaches, ultimately optimizing patient outcomes and minimizing the potential harms of both undertreatment and overtreatment. Addressing the diagnostic challenges posed by indeterminate thyroid nodules remains a critical focus in advancing thyroid cancer care.
