{"id":"https://openalex.org/W7216259729","doi":"https://doi.org/10.3390/cancers18193186","title":"Variability in the Risk of Malignancy in Bethesda IV Thyroid Nodules: Results from the EUROCRINE Surgical Registry","display_name":"Variability in the Risk of Malignancy in Bethesda IV Thyroid Nodules: Results from the EUROCRINE Surgical Registry","publication_year":2026,"publication_date":"2026-10-02","ids":{"openalex":"https://openalex.org/W7216259729","doi":"https://doi.org/10.3390/cancers18193186","pmid":"https://pubmed.ncbi.nlm.nih.gov/42882882","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13664412"},"language":"en","primary_location":{"id":"doi:10.3390/cancers18193186","doi":"https://doi.org/10.3390/cancers18193186","is_oa":true,"landing_page_url":"https://doi.org/10.3390/cancers18193186","pdf_url":null,"source":{"id":"https://openalex.org/S168415115","display_name":"Cancers","issn_l":"2072-6694","issn":["2072-6694"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cancers","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.3390/cancers18193186","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5031184325","display_name":"Piotr Wi\u015bniewski","orcid":"https://orcid.org/0000-0002-4411-577X","observed_orcids":["https://orcid.org/0000-0002-4411-577X"]},"institutions":[{"id":"https://openalex.org/I75124487","display_name":"Gda\u0144sk Medical University","ror":"https://ror.org/019sbgd69","country_code":"PL","type":"education","lineage":["https://openalex.org/I75124487"]}],"countries":["PL"],"is_corresponding":false,"raw_author_name":"Piotr Wi\u015bniewski","raw_affiliation_strings":["Department of Endocrinology and Internal Diseases, Medical University of Gda\u0144sk, 80-214 Gdansk, Poland"],"raw_orcid":"https://orcid.org/0000-0002-4411-577X","affiliations":[{"raw_affiliation_string":"Department of Endocrinology and Internal Diseases, Medical University of Gda\u0144sk, 80-214 Gdansk, Poland","institution_ids":["https://openalex.org/I75124487"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5043833589","display_name":"Maciej \u015aledzi\u0144ski","orcid":"https://orcid.org/0000-0001-5983-3689","observed_orcids":["https://orcid.org/0000-0001-5983-3689"]},"institutions":[{"id":"https://openalex.org/I75124487","display_name":"Gda\u0144sk Medical University","ror":"https://ror.org/019sbgd69","country_code":"PL","type":"education","lineage":["https://openalex.org/I75124487"]}],"countries":["PL"],"is_corresponding":false,"raw_author_name":"Maciej \u015aledzi\u0144ski","raw_affiliation_strings":["Department of Surgical Oncology, Transplant Surgery and General Surgery, Medical University of Gda\u0144sk, 80-214 Gdansk, Poland"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Surgical Oncology, Transplant Surgery and General Surgery, Medical University of Gda\u0144sk, 80-214 Gdansk, Poland","institution_ids":["https://openalex.org/I75124487"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5014243379","display_name":"Marcin Barczy\u0144ski","orcid":"https://orcid.org/0000-0001-6062-1851","observed_orcids":["https://orcid.org/0000-0001-6062-1851"]},"institutions":[{"id":"https://openalex.org/I126596746","display_name":"Jagiellonian University","ror":"https://ror.org/03bqmcz70","country_code":"PL","type":"education","lineage":["https://openalex.org/I126596746"]}],"countries":["PL"],"is_corresponding":false,"raw_author_name":"Marcin Barczy\u0144ski","raw_affiliation_strings":["Faculty of Medicine, Department of Endocrine Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Faculty of Medicine, Department of Endocrine Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland","institution_ids":["https://openalex.org/I126596746"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5059959042","display_name":"Andrzej Rafal Hellmann","orcid":"https://orcid.org/0000-0002-9258-3244","observed_orcids":["https://orcid.org/0000-0002-9258-3244"]},"institutions":[{"id":"https://openalex.org/I75124487","display_name":"Gda\u0144sk Medical University","ror":"https://ror.org/019sbgd69","country_code":"PL","type":"education","lineage":["https://openalex.org/I75124487"]}],"countries":["PL"],"is_corresponding":true,"raw_author_name":"Andrzej Rafa\u0142 Hellmann","raw_affiliation_strings":["Department of Surgical Oncology, Transplant Surgery and General Surgery, Medical University of Gda\u0144sk, 80-214 Gdansk, Poland"],"raw_orcid":"https://orcid.org/0000-0002-9258-3244","affiliations":[{"raw_affiliation_string":"Department of Surgical Oncology, Transplant Surgery and General Surgery, Medical University of Gda\u0144sk, 80-214 Gdansk, Poland","institution_ids":["https://openalex.org/I75124487"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5059959042"],"corresponding_institution_ids":["https://openalex.org/I75124487"],"apc_list":{"value":2900,"currency":"CHF","value_usd":3499},"apc_paid":{"value":2900,"currency":"CHF","value_usd":3499},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.71129652,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"18","issue":"19","first_page":"3186","last_page":"3186"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10329","display_name":"Thyroid Cancer Diagnosis and Treatment","score":0.9907000064849854,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10329","display_name":"Thyroid Cancer Diagnosis and Treatment","score":0.9907000064849854,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11728","display_name":"Thyroid and Parathyroid Surgery","score":0.008200000040233135,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10202","display_name":"Lung Cancer Diagnosis and Treatment","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2740","display_name":"Pulmonary and Respiratory Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/follicular-neoplasm","display_name":"follicular neoplasm","score":0.9509999752044678},{"id":"https://openalex.org/keywords/cancer-risk","display_name":"cancer risk","score":0.9430000185966492},{"id":"https://openalex.org/keywords/inter-center-variability","display_name":"inter-center variability","score":0.6299999952316284},{"id":"https://openalex.org/keywords/risk-stratification","display_name":"risk stratification","score":0.6710000038146973},{"id":"https://openalex.org/keywords/overdiagnosis","display_name":"overdiagnosis","score":0.7559999823570251},{"id":"https://openalex.org/keywords/thyroid-surgery","display_name":"thyroid surgery","score":0.47200000286102295},{"id":"https://openalex.org/keywords/decision-curve-analysis","display_name":"decision curve analysis","score":0.6639999747276306},{"id":"https://openalex.org/keywords/intraclass-correlation-coefficient","display_name":"intraclass correlation coefficient","score":0.5559999942779541},{"id":"https://openalex.org/keywords/thyroid-nodule-management","display_name":"thyroid nodule management","score":0.4390000104904175}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8082000017166138},{"id":"https://openalex.org/C2779377019","wikidata":"https://www.wikidata.org/wiki/Q956131","display_name":"Overdiagnosis","level":2,"score":0.788100004196167},{"id":"https://openalex.org/C2779022025","wikidata":"https://www.wikidata.org/wiki/Q53829","display_name":"Thyroid nodules","level":3,"score":0.6762999892234802},{"id":"https://openalex.org/C2779399171","wikidata":"https://www.wikidata.org/wiki/Q1483951","display_name":"Malignancy","level":2,"score":0.6123999953269958},{"id":"https://openalex.org/C151956035","wikidata":"https://www.wikidata.org/wiki/Q1132755","display_name":"Logistic regression","level":2,"score":0.59579998254776},{"id":"https://openalex.org/C104709138","wikidata":"https://www.wikidata.org/wiki/Q1671540","display_name":"Intraclass correlation","level":3,"score":0.5196999907493591},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.48989999294281006},{"id":"https://openalex.org/C2779761222","wikidata":"https://www.wikidata.org/wiki/Q826522","display_name":"Thyroid cancer","level":3,"score":0.4230000078678131},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.4120999872684479},{"id":"https://openalex.org/C526584372","wikidata":"https://www.wikidata.org/wiki/Q16399","display_name":"Thyroid","level":2,"score":0.3813999891281128},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.373199999332428},{"id":"https://openalex.org/C2776316164","wikidata":"https://www.wikidata.org/wiki/Q1483951","display_name":"Benignity","level":3,"score":0.36169999837875366},{"id":"https://openalex.org/C2779974597","wikidata":"https://www.wikidata.org/wiki/Q28448986","display_name":"Clinical Practice","level":2,"score":0.35659998655319214},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.3425000011920929},{"id":"https://openalex.org/C3018260909","wikidata":"https://www.wikidata.org/wiki/Q1322871","display_name":"Exploratory analysis","level":2,"score":0.3368000090122223},{"id":"https://openalex.org/C143998085","wikidata":"https://www.wikidata.org/wiki/Q162555","display_name":"Oncology","level":1,"score":0.31040000915527344},{"id":"https://openalex.org/C126838900","wikidata":"https://www.wikidata.org/wiki/Q77604","display_name":"Radiology","level":1,"score":0.30640000104904175},{"id":"https://openalex.org/C12174686","wikidata":"https://www.wikidata.org/wiki/Q1058438","display_name":"Risk assessment","level":2,"score":0.29989999532699585},{"id":"https://openalex.org/C188087704","wikidata":"https://www.wikidata.org/wiki/Q369577","display_name":"Standardization","level":2,"score":0.29980000853538513},{"id":"https://openalex.org/C121608353","wikidata":"https://www.wikidata.org/wiki/Q12078","display_name":"Cancer","level":2,"score":0.296099990606308},{"id":"https://openalex.org/C2778527826","wikidata":"https://www.wikidata.org/wiki/Q1787017","display_name":"Cancer registry","level":3,"score":0.2903999984264374},{"id":"https://openalex.org/C152877465","wikidata":"https://www.wikidata.org/wiki/Q208042","display_name":"Regression analysis","level":2,"score":0.28529998660087585},{"id":"https://openalex.org/C530470458","wikidata":"https://www.wikidata.org/wiki/Q128581","display_name":"Breast cancer","level":3,"score":0.2605000138282776},{"id":"https://openalex.org/C2779159551","wikidata":"https://www.wikidata.org/wiki/Q1414874","display_name":"Comorbidity","level":2,"score":0.25949999690055847},{"id":"https://openalex.org/C2776035688","wikidata":"https://www.wikidata.org/wiki/Q1606558","display_name":"Affect (linguistics)","level":2,"score":0.25870001316070557},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.25760000944137573},{"id":"https://openalex.org/C2777615720","wikidata":"https://www.wikidata.org/wiki/Q11888847","display_name":"Prioritization","level":2,"score":0.2535000145435333}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.3390/cancers18193186","doi":"https://doi.org/10.3390/cancers18193186","is_oa":true,"landing_page_url":"https://doi.org/10.3390/cancers18193186","pdf_url":null,"source":{"id":"https://openalex.org/S168415115","display_name":"Cancers","issn_l":"2072-6694","issn":["2072-6694"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cancers","raw_type":"journal-article"},{"id":"pmid:42882882","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42882882","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cancers","raw_type":"Journal Article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13664412","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13664412/","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cancers (Basel)","raw_type":"Text"}],"best_oa_location":{"id":"doi:10.3390/cancers18193186","doi":"https://doi.org/10.3390/cancers18193186","is_oa":true,"landing_page_url":"https://doi.org/10.3390/cancers18193186","pdf_url":null,"source":{"id":"https://openalex.org/S168415115","display_name":"Cancers","issn_l":"2072-6694","issn":["2072-6694"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cancers","raw_type":"journal-article"},"sustainable_development_goals":[{"score":0.9537000060081482,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":21,"referenced_works":["https://openalex.org/W1951724000","https://openalex.org/W1996421956","https://openalex.org/W2007160870","https://openalex.org/W2035919693","https://openalex.org/W2077963729","https://openalex.org/W2083254705","https://openalex.org/W2093010205","https://openalex.org/W2145150141","https://openalex.org/W2226880313","https://openalex.org/W2605740401","https://openalex.org/W2742257046","https://openalex.org/W2791773508","https://openalex.org/W2792205871","https://openalex.org/W2986758724","https://openalex.org/W3000711179","https://openalex.org/W3155475249","https://openalex.org/W3172245730","https://openalex.org/W4224231269","https://openalex.org/W4302293013","https://openalex.org/W4382011628","https://openalex.org/W4399742228"],"related_works":["https://openalex.org/W7128470686","https://openalex.org/W7165904062","https://openalex.org/W7214651946","https://openalex.org/W7213274717","https://openalex.org/W3175303518","https://openalex.org/W7139012041","https://openalex.org/W4377014449","https://openalex.org/W7117809655","https://openalex.org/W3155475249","https://openalex.org/W4413637196"],"abstract_inverted_index":{"Background/Objectives:":[0],"The":[1,171],"management":[2,271],"of":[3,22,59,122,166,174,256],"Bethesda":[4,80],"IV":[5,81],"(follicular":[6],"neoplasm)":[7],"thyroid":[8,82],"nodules":[9,83],"remains":[10],"controversial,":[11],"in":[12,18,34,85,228,236,277],"part":[13],"due":[14],"to":[15,47,95,130,149],"wide":[16],"variation":[17,100],"the":[19,60,86,126,175,188,252],"reported":[20],"risk":[21,134],"malignancy":[23,199],"(ROM-BIV).":[24],"Understanding":[25],"this":[26],"variability":[27,50,227],"is":[28],"essential":[29],"for":[30,38,106,157,161,198,254,269],"documenting":[31],"systemic":[32],"inconsistencies":[33],"ROM-BIV":[35,49,97,142,167,229],"estimates":[36],"and":[37,54,98,103,108,113,159,195,243,258,272],"developing":[39],"more":[40],"consistent":[41],"risk-stratification":[42],"strategies.":[43],"This":[44],"study":[45],"aimed":[46],"quantify":[48],"across":[51,101,230],"European":[52,231],"centers":[53,102,232],"conduct":[55],"an":[56],"exploratory":[57],"analysis":[58,112,116,186,203],"trade-offs":[61],"associated":[62],"with":[63,79],"hypothetical":[64],"risk-based":[65],"thresholds":[66],"within":[67,125],"a":[68,205],"surgically":[69,127],"selected":[70],"cohort.":[71],"Methods:":[72],"We":[73],"analyzed":[74],"data":[75],"from":[76,147],"15,251":[77],"patients":[78],"enrolled":[84],"EUROCRINE":[87],"registry.":[88],"Multilevel":[89],"logistic":[90],"regression":[91],"models":[92,262],"were":[93,117,155],"used":[94],"estimate":[96],"assess":[99],"countries,":[104,162],"adjusting":[105],"patient-":[107],"nodule-level":[109],"characteristics.":[110],"Threshold":[111],"decision":[114],"curve":[115,202],"employed":[118],"as":[119,266],"illustrative":[120],"mappings":[121],"trade-off":[123,190],"mechanisms":[124],"treated":[128],"cohort":[129],"explore":[131],"how":[132],"varying":[133],"levels":[135],"affect":[136],"classification":[137],"outcomes.":[138],"Results:":[139],"Adjusted":[140],"center-level":[141],"demonstrated":[143],"marked":[144],"variability,":[145],"ranging":[146],"5.5%":[148],"65.5%.":[150],"Intraclass":[151],"correlation":[152],"coefficients":[153],"(ICCs)":[154],"11.4%":[156],"institutions":[158],"9.7%":[160],"indicating":[163],"meaningful":[164],"clustering":[165],"at":[168],"both":[169],"levels.":[170],"fixed":[172],"component":[173],"model":[176],"showed":[177],"limited-to-moderate":[178],"discrimination":[179],"(AUC-ROC":[180],"0.647;":[181],"95%":[182],"CI,":[183],"0.637\u20130.656).":[184],"Exploratory":[185],"illustrated":[187],"inherent":[189],"between":[191],"reducing":[192],"potential":[193],"overdiagnosis":[194],"maintaining":[196],"sensitivity":[197],"detection.":[200],"Decision":[201],"indicated":[204],"theoretical":[206],"net":[207],"benefit":[208],"over":[209],"default":[210],"strategies,":[211],"although":[212],"no":[213],"specific":[214],"clinical":[215,241,282],"threshold":[216],"could":[217],"be":[218,264,285],"recommended":[219],"based":[220],"on":[221],"these":[222],"retrospective":[223],"data.":[224],"Conclusions:":[225],"Substantial":[226],"may":[233],"reflect":[234],"differences":[235],"institutional":[237],"selection,":[238],"diagnostic":[239,257],"practices,":[240],"management,":[242],"reporting,":[244],"rather":[245],"than":[246],"biological":[247],"variance.":[248],"These":[249],"findings":[250],"highlight":[251],"need":[253],"standardization":[255],"reporting":[259],"pathways.":[260],"Risk-based":[261],"must":[263],"positioned":[265],"supportive":[267],"tools":[268],"individualized":[270],"require":[273],"rigorous":[274],"prospective":[275],"validation":[276],"unselected":[278],"populations":[279],"before":[280],"any":[281],"implementation":[283],"can":[284],"considered.":[286]},"counts_by_year":[],"updated_date":"2026-10-29T09:56:32.521200","created_date":"2026-10-03T00:00:00"}