Assessing the Accuracy of Thyroid Nodule Risk Stratification Tools in Hispanic and Non-Hispanic Patients

Abstract Purpose Ultrasound risk categories (TI-RADS), fine-needle aspiration (FNA) cytology (Bethesda), and molecular classifiers guide thyroid nodule management. However, these tools may perform differently across populations due to differences in thyroid cancer characteristics among Hispanic patients. We compared the predictive performance of these tools in Hispanic versus non-Hispanic patients using surgical pathology as the gold standard. Methods We performed a retrospective study of adult patients (≥18 years) evaluated for thyroid nodules from January 2023 through June 2024 at a tertiary academic medical center. Nodules were stratified using TI-RADS, Bethesda and molecular testing. Malignancy was confirmed by final surgical pathology, and positive predictive value was assessed within diagnostic strata among resected nodules. Results 308 patients (421 nodules) were included in the analytic cohort, with 29.2% being Hispanic. Mean age was 54.3 ± 15.4 years in Hispanic patients and 58.8 ± 16.1 years in non-Hispanic patients (p=0.02). TI-RADS and Bethesda distributions were similar by ethnicity. Among TI-RADS4 nodules undergoing surgery, malignancy risk was higher in Hispanic patients (32.7% vs 12.0%; OR 3.57, 95% CI 1.63-7.78; p=0.001). Among Bethesda III/IV nodules with suspicious molecular results, malignancy was higher in Hispanic patients (78.6% vs 34.8%; adjusted OR 8.72, 95% CI 1.35-96.0; p=0.022). Overall, Hispanic patients had higher odds of malignancy (OR 2.14, 95% CI 1.26-3.64; p=0.0047). Conclusions Despite similar use of diagnostic tools, Hispanic patients had higher malignancy rates overall and within select diagnostic strata. These findings suggest variation in risk estimate performance across populations and support multi-center validation in diverse cohorts.