Re: “American Thyroid Association and Thyroid Imaging Reporting and Data System developed by the American College of Radiology: which one is better at predicting malignancy risk?” in thyroidology

Dear Editor,

We read with a great deal and interest the research article entitled “American Thyroid Association and Thyroid Imaging Reporting and Data System developed by the American College of Radiology: which one is better at predicting malignancy risk?” by Andreda and colleagues¹. This beneficial research of high quality seems to demand determining in order of comparing the capacity of the 2015 American Thyroid Association (ATA)² and the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS)³ in predicting malignancy risk of thyroid nodules. We postulate that Andreda et al.¹ performed a worthy comparison of ATA and ACR-TIRADS in terms of avoiding unnecessary fine needle aspiration (FNA) application, a valued and crucial issue in the thyroid lexicon, which has recently been published in the 67th volume of Rev Assoc Med Bras. However, we would like to emphasize some issues in thyroidology for the aforementioned study. First of all, thyroid nodules should be stated as a common clinical diagnostic challenge instead of a common clinical diagnosis (probably, a misspelling). Second, the authors reported the details of the ultrasound (a B-mode sonography) but not the size(s) and applying method(s) of the fine needles which had been used for the sampling procedures from the mentioned nodules to present them to the Department of (Cyto)Pathology. A wide range of (20–27 gauge in size) needles have been used for the procedure in different geographical regions (e.g., 25–27 gauge in most Western countries and 21–22 gauge in Japan)⁴. Debate is still ongoing on an optimal needle size for thyroid FNA cytology in thyroidology. In this sense, we reported a favorable non-diagnostic cytology rate on a sum of 500 nodules in 425 eligible consecutive outpatients during 38 months, involving ultrasonography (US)-guided FNA with a surgeon-performed US (SUS) in thyroid nodules with 27-G fine needles⁵–¹². Therefore, would the outcomes of the study at that point be altered as they had harnessed significantly (i) finer or (ii) larger needle sizes? Herein, is it essential, at least, to state the relevant gauge(s) in order to design this deducing valued educational and technical study? Third, the authors emphasized that “the nodules with Category I, III, and IV, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)¹³, were not included in the analysis due to the impossibility of assigning its behavior.” Nevertheless, they enunciated their purpose of comparing the capacity of the 2015 ATA² and the 2017 ACR-TIRADS³ in predicting the malignancy risk of thyroid nodules¹. Today, it has been widely accepted by thyroidologists that non-diagnostic (Category I) and indeterminate cytology (Categories III, IV, and V), in particular, TBSRTC, mostly deserve to be able to estimate an optimal and accurate malignancy risk. In addition, indeterminate cytology is constituted by Categories III, IV, and V² but not “III and IV¹”, TBSRTC¹³. Furthermore, Category V, per se, is not “malign” and even cannot “be considered malign”. Furthermore, mutational testing for BRAF or the seven-gene mutation marker panel (BRAF, RAS, RET/PTC, PAX8/PPARc) is recommended today in nodules suspicious for malignancy, Category V, cytology after consideration of clinical and sonographic features if such data would be expected to alter surgical decision-making². Breviter, disorders with their diagnostic options of this papilionaceous and delicate endocrine gland remain their significance in tellurian¹–²³. As such, this work published in the 67th volume of Rev Assoc Med Bras¹ is crucial for endocrine surgeons, endocrine pathologists, endocrinologists, head & neck surgeons and radiologists, otorhinolaryngologists, and thyroidologists, who stay informed of the growing spectrum of clinical management for challenging nodules for these thyroid providers and thyroid health as different peas in a pod²⁴–²⁹. This issue merits further investigation. We thank Andreda et al.¹ for their valuable study.

• Funding: none.

REFERENCES

• ¹
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• ²
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Publication Dates

• Publication in this collection
  03 May 2024
• Date of issue
  2024

History

• Received
  18 Nov 2023
• Accepted
  19 Nov 2023