High suspicion US pattern on the ATA guidelines, not cytologic diagnosis, may be a predicting marker of lymph node metastasis in patients with classical papillary thyroid carcinoma

To evaluate the utility of ultrasound (US) patterns based on the 2015 American Thyroid Association (ATA) guidelines and cytologic diagnosis of the Bethesda System for Reporting Thyroid Cytopathology as predicting markers for lymph node metastasis (LNM) in classical papillary thyroid carcinoma (PTC). A retrospective analysis of 657 patients with classical PTC who underwent ultrasound-guided fine-needle aspiration (US-FNA) and surgery were included in this study. The associations between LNM and the US features or the Bethesda System for Reporting Thyroid Cytopathology were evaluated. Multivariate logistic regression analysis showed that the high suspicion US pattern was independently associated with LNM (odds ratio = 3.081; 95% confidence interval = 1.515–6.262; P = .002). And the Bethesda category was not significantly associated with LNM (P = .056). The high suspicion US pattern of the 2015 ATA guidelines, not cytologic diagnosis, could be a predicting marker of LNM in patients with classical PTC. •Lymph node metastasis as a strong predictor of the recurrence in papillary thyroid carcinoma.•Associations between lymph node metastasis and the US features or the cytologic diagnosis.•The Bethesda category not as a prognostic marker of lymph node metastasis.•The high suspicion US pattern based on ATA guideline as a predicting marker of lymph node metastasis.