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Letter to the Editor • Rev. Assoc. Med. Bras. 71 (6) • 2025 • https://doi.org/10.1590/1806-9282.20250425 linkcopy

Open-access Annotating sonography-guided fine-needle aspiration cytology in the management of thyroid nodules in thyroidology

AuthorshipSCIMAGO INSTITUTIONS RANKINGS

Dear Editor,

Tyroidology, a dynamic discipline, deals with disorders and therapeutic options of the delicate papillon gland, the thyroid, which may demand a gracious approach in human beings1,2. We read with great interest and respect to the research article entitled "The Impact of Ultrasound-Guided Fine-Needle Aspiration Cytology in the Management of Thyroid Nodule." This beneficial research seems to demand a determining efficacy of the ultrasonography (US)-guided fine-needle aspiration (FNA) in thyroid nodules by comparing palpation-guided FNA in 456 outpatients over 12 months3. Riju et al.3 declared in their study that US-FNA utilization attenuated the inadequacy. The authors remarked in their work that they used 24-gauge (G) needles for the interventional procedures of the thyroid nodules. They emphasized not using any local anesthetic agents for these sampling procedures. Riju et al.3 pointed out that the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), 3rd edition (ed), was used to evaluate the cytology of suspicious thyroid nodules. However, a wide range of needle sizes, 20–27-G, have been used for FNA applications in different geographic regions worldwide, that is, 25–27-G in most Western countries and 21–22-G in Japan4-8. In addition, we mentioned Category III, TBSRTC, 3rd ed., from another perspective and recommended the requirement of zooming in thyroid nodules in suspense, 10–15 mm with repeat cytology in the 2nd issue, Volume 67, Revista da Associação Médica Brasileira9. Moreover, we emphasized whether it is essential to maintain Category III, TBSRTC, 3rd ed., as a unique and indivisible category within indeterminate cytology of thyroid nodules or not, published in the 10th issue, Volume 67, Revista da Associação Médica Brasileira10, prior to the 3rd edition of this lexicon, the 2023 TBSRTC, by Ali et al.11 in Thyroid, which has been announced after two former successful editions by Cibas et al.12,13 Lastly, we have recommended working with subsets to resolve the ongoing debate on "indeterminate cytology," similar to "intermediate suspicion" in radiology14. Therefore, would the utilization of thicker or finer needles alter1,2,4-8 the outcome(s) of this study? Furthermore, would harnessing a topical and/or local anesthesia prior to the procedure transmute1,2,4,5,7 the desinence(s) of this work? Moreover, would a feasible application of the novel subgroups of Category III, TBSRTC, 3rd ed, switch or modify the consequence(s) of this study in thyroidology?9,11-15 This issue merits further investigation. We thank Riju et al.3 for their valuable study.

  • Funding:
    none.

DATA AVAILABILITY STATEMENT

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

REFERENCES

  • 1 Sengul I, Sengul D. Proposal of a novel terminology: minimally invasive FNA and thyroid minimally invasive FNA; MIFNA and thyroid MIFNA. Ann Ital Chir. 2021;92:330-1. PMID: 34312332
  • 2 Sengul D, Sengul I. Minimum minimorum: thyroid minimally invasive FNA, less is more concept? Volens nolens?. Rev Assoc Med Bras (1992). 2022;68(3):275-6. https://doi.org/10.1590/1806-9282.20211181
    » https://doi.org/10.1590/1806-9282.20211181
  • 3 Riju J, Thomas N, Paul TV, Abraham D, Jacob PM, Prabhu AJ, et al. The impact of ultrasound-guided fine-needle aspiration cytology in the management of thyroid nodule. Indian J Surg Oncol. 2024. https://doi.org/10.1007/s13193-024-02158-8
    » https://doi.org/10.1007/s13193-024-02158-8
  • 4 Sengul I, Sengul D. Apropos of quality for fine-needle aspiration cytology of thyroid nodules with 22-, 23-, 25-, even 27-gauge needles and indeterminate cytology in thyroidology: an aide memory. Rev Assoc Med Bras (1992). 2022;68(8):987-8. https://doi.org/10.1590/1806-9282.20220498
    » https://doi.org/10.1590/1806-9282.20220498
  • 5 Sengul D, Sengul I. Reinterpretation on a comparison of cytological adequacy between 23- and 25-gauge in thyroidology: smaller needle gauges "ratio"nale or (over)use it? Rev Assoc Med Bras (1992). 2024;70(11):e20240874. https://doi.org/10.1590/1806-9282.20240874
    » https://doi.org/10.1590/1806-9282.20240874
  • 6 Maeda H, Kutomi G, Satomi F, Shima H, Mori M, Hirata K, et al. Clinicopathological characteristics of thyroid cancer misdiagnosed by fine needle aspiration. Exp Ther Med. 2016;12(4):2766-72. https://doi.org/10.3892/etm.2016.3651
    » https://doi.org/10.3892/etm.2016.3651
  • 7 Sengul D, Sengul I, Slycke S. Risk stratification of the thyroid nodule with Bethesda indeterminate cytology, category III, IV, V on the one surgeon-performed US-guided fine-needle aspiration with 27-gauge needle, verified by histopathology of thyroidectomy: the additional value of one surgeon-performed elastography. Acta Chir Belg. 2019;119(1):38-46. https://doi.org/10.1080/00015458.2018.1551769
    » https://doi.org/10.1080/00015458.2018.1551769
  • 8 Sengul D, Sengul I. A closer look at the size cutoff of 10 mm, below 10 mm in particular, in thyroidology: debate is still ongoing. Rev Assoc Med Bras (1992). 2021;67(11):1523-4. https://doi.org/10.1590/1806-9282.20210856
    » https://doi.org/10.1590/1806-9282.20210856
  • 9 Sengul I, Sengul D. Focusing on thyroid nodules in suspense: 10-15 mm with repeat cytology, category III, the Bethesda System for Reporting Thyroid Cytopathology, TBSRTC. Rev Assoc Med Bras (1992). 2021;67(2):166-7. https://doi.org/10.1590/1806-9282.67.02.20200828
    » https://doi.org/10.1590/1806-9282.67.02.20200828
  • 10 Sengul I, Sengul D. Blurred lines for management of thyroid nodules in the era of atypia of undetermined significance/ follicular lesion of undetermined significance: novel subdivisions of categories IIIA and IIIB in a possible forthcoming The Bethesda System for Reporting Thyroid Cytopathology, 3rd edition; amending versus unnecessary? Rev Assoc Med Bras (1992). 2021;67(10):1385-6. https://doi.org/10.1590/1806-9282.20210763
    » https://doi.org/10.1590/1806-9282.20210763
  • 11 Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA. The 2023 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2023;33(9):1039-44. https://doi.org/10.1089/thy.2023.0141
    » https://doi.org/10.1089/thy.2023.0141
  • 12 Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2009;19(11):1159-65. https://doi.org/10.1089/thy.2009.0274
    » https://doi.org/10.1089/thy.2009.0274
  • 13 Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2017;27(11):1341-6. https://doi.org/10.1089/thy.2017.0500
    » https://doi.org/10.1089/thy.2017.0500
  • 14 Sengul D, Sengul I. Subdivision of intermediate suspicion, the 2021 K-TIRADS, and category III, indeterminate cytology, the 2017 TBSRTC, 2nd edition, in thyroidology: let bygones be bygones? Ultrasonography. 2023;42(4):600-1. https://doi.org/10.14366/usg.23113
    » https://doi.org/10.14366/usg.23113
  • 15 Sengul D, Sengul I, Soares Junior JM. Repercussion of thyroid dysfunctions in thyroidology on the reproductive system: conditio sine qua non? Rev Assoc Med Bras (1992). 2022;68(6):721-2. https://doi.org/10.1590/1806-9282.20220255
    » https://doi.org/10.1590/1806-9282.20220255

Edited by

Publication Dates

  • Publication in this collection
    07 July 2025
  • Date of issue
    2025

History

  • Received
    01 Jan 2025
  • Accepted
    03 Mar 2025
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