What question did this study set out to answer?

To evaluate cytologic outcomes and compare malignancy risk in thyroid nodules ≥ 4 cm using TIRADS and size-based assessments.

February 25, 2026Open Access

Thyroid Fine Needle Aspiration of Nodules ≥ 4 cm: Cytologic Outcomes and Risk Stratification in a Tertiary Centre

Key Points

To evaluate cytologic outcomes and compare malignancy risk in thyroid nodules ≥ 4 cm using TIRADS and size-based assessments.
Retrospective review of thyroid FNAs conducted from January 2012 to August 2025.
Data collected included age, gender, nodule size, TIRADS, indication for FNA, and Bethesda categories.
Nodules were classified as benign/non-diagnostic or indeterminate/malignant based on Bethesda classification.
Statistical analysis was performed using chi-square test.
A total of 486 nodules ≥ 4 cm underwent FNA, with two groups based on TIRADS and size only.
The size-only group had 11.5% indeterminate/malignant results, while the TIRADS group had 20.7%.
Statistical analysis showed a significant difference (chi-square = 3.91, p = 0.048).

Abstract

ABSTRACT Objectives To assess cytologic outcomes of thyroid nodules ≥ 4 cm undergoing FNA and compare malignancy risk between nodules that underwent an FNA by TIRADS criteria versus size alone. Methods A retrospective review of thyroid FNAs from January 2012 to August 2025 was conducted. Nodules ≥ 4 cm were included, with data extracted from RIS and pathology records. Age, gender, nodule size, TIRADS, FNA indication, and Bethesda category were recorded. Cytology was grouped into benign/non‐diagnostic (Bethesda I–II) versus indeterminate/malignant (Bethesda III–VI). The Bethesda classification (I–VI) corresponds to increasing malignancy risk. Statistical analysis used a chi‐square test ( p 10% of large nodules without suspicious features were Bethesda III or higher, FNA is recommended for all nodules ≥ 4 cm to minimise missed malignancies.

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