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Scientific Oral Presentation

Head and Neck Surgery

Clinical Correlates of Thyroid Cancer in Indeterminate Nodules

Sunday, October 18, 2026
8:12 AM - 8:18 AM PT
Location: West Exhibit Hall A, Learning Zone 3

    Presenting Author(s)

  • HS

    Hyun Song, n/a

    Medical Student
    Albert Einstein College of Medicine
    Bronx, New York, United States

    • Senior Author(s)

  • Helen Levyn, MD

    Otorhinolaryngologist—Head & Neck Surgeon
    Montefiore/Einstein
    New York, NY, United States

    • Co-Author(s)

  • RB

    Rachel Berglas, BA

    Medical Student
    Albert Einstein College of Medicine
    Spring Valley, NY, United States

  • Sara Friedman, BA

    Medical Student
    Albert Einstein College of Medicine
    Bronx, New York, United States

  • SA

    Salma Ahsanuddin, MD

    Otorhinolaryngology - Resident Doctor
    Montefiore/Einstein, United States

  • RS

    Richard V. Smith, MD

    Professor and Chair, Department of Otorhinolaryngology-Head and Neck Surgery
    Montefiore/Einstein
    Bronx, NY, United States

  • Vikas Mehta, MD MPH

    Professor of Otolaryngology
    Montefiore Medical Center
    Bronx, New York, United States

Introduction: Indeterminate thyroid nodules (ITN), classified as Bethesda III/IV cytology, present a persistent management challenge. Molecular testing such as ThyroSeq is increasingly used to further assess malignancy risk and guide management. However, its added predictive value beyond demographic and clinical features remains unclear. This study evaluated the association of demographic, sonographic, cytological, and molecular variables to the risk of thyroid cancer in ITNs.

Methods: Following institutional IRB approval, consecutive ITN that underwent ThyroSeq followed by surgical resection at a single tertiary urban institution from 3/2018-12/2024 were included (n=121). Age, sex, race, ethnicity, nodule size, TIRADS, Bethesda category, and ThyroSeq result were abstracted. Univariate logistic regression was performed for each covariate, followed by multivariate logistic regression. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features was classified as non-malignant for the purpose of this study.

Results: On univariable analysis, higher-risk US (TR4/5; OR=4.71, p=0.0037) and positive ThyroSeq (OR=3.2, p=0.008) were significantly associated with malignancy. Age>55, male sex, race, ethnicity, Bethesda IV, and nodule size were not significantly associated with malignancy. In multivariable analysis (n=73), cytologic classification independently predicted malignancy (OR=2.89, p=0.0051), whereas TIRADS (OR=1.09, p=0.06) and ThyroSeq (OR=2.70, p=0.19) result were not independent predictors.

Conclusions: In this single-institution cohort, demographic characteristics and nodule size were not predictive of clinically significant malignancy in ITNs. Bethesda classification emerged as the sole independent predictor, underscoring the need for a holistic, patient-centered assessment and highlighting that traditional prognostic factors in thyroid cancer do not reliably predict malignancy risk in ITNs. Molecular testing and ultrasound findings should therefore be interpreted judiciously when guiding management decisions in this population.