Optimal needle size for thyroid fine-needle aspiration (FNA) cytology has not been established distinctly and conclusively in thyroidology to-date. The literature on the subject is scarce. We read with respect the research article, entitled: “Optimal needle size for thyroid fine-needle aspiration cytology11 Tanaka A, Hirokawa M, Higuchi M, Kanematsu R, Suzuki A, Kuma S, et al. Optimal needle size for thyroid fine needle aspiration cytology. Endocr J. 2019;66(2):143-7. https://doi.org/10.1507/endocrj.EJ18-0422
https://doi.org/10.1507/endocrj.EJ18-042...
.” Tanaka et al.11 Tanaka A, Hirokawa M, Higuchi M, Kanematsu R, Suzuki A, Kuma S, et al. Optimal needle size for thyroid fine needle aspiration cytology. Endocr J. 2019;66(2):143-7. https://doi.org/10.1507/endocrj.EJ18-0422
https://doi.org/10.1507/endocrj.EJ18-042...
declared to utilize two different sizes, 22- and 25-gauges, of needles for the FNA procedures. The authors reported the nondiagnostic/unsatisfactory rates of 22- and 25-gauge needles were being as 18.5% and 21.0%, respectively. Nevertheless, we currently reported the possible efficacy of nodule size of 10- and 15-mm in the greatest dimension, as the cutoff points, on three diagnostic tools; (i) strain elastography (SE), (ii) ultrasonography-guided FNA (US-FNA) cytology, and (iii) histopathology22 Sengul D, Sengul I, Egrioglu E, Ozturk T, Aydın I, Kesicioglu T, et al. Can cut-off points of 10 and 15 mm of thyroid nodule predict malignancy on the basis of three diagnostic tools: i) strain elastography, ii) the Bethesda System for Reporting Thyroid Cytology with 27-gauge fine-needle, and iii) histopathology? J BUON. 2020;25(2):1122-9. PMID: 32521915. We had utilized just 27-gauge fine-needle (Hayat, 2 ml 3P 27-G, 0.40×50 mm, Istanbul, Turkey) by performing US-FNA for a total of 425 cases with 500 thyroid nodules by the surgeon-performed ultrasonography (SUS), based on the revised American Thyroid Association (ATA) management guidelines for patients with thyroid nodules and differentiated thyroid cancer [i.e. low, intermediate, and high suspicion nodules; 2015 ATA management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer] for the duration of 3 years and 2 months22 Sengul D, Sengul I, Egrioglu E, Ozturk T, Aydın I, Kesicioglu T, et al. Can cut-off points of 10 and 15 mm of thyroid nodule predict malignancy on the basis of three diagnostic tools: i) strain elastography, ii) the Bethesda System for Reporting Thyroid Cytology with 27-gauge fine-needle, and iii) histopathology? J BUON. 2020;25(2):1122-9. PMID: 32521915,33 Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. https://doi.org/10.1089/thy.2015.0020
https://doi.org/10.1089/thy.2015.0020...
. This is a considerable and novel ‘SUS-based’ US-FNA thyroid study for the specific and also ‘well-accepted crucial’ size cutoffs of 10- and 15-mm in endocrine surgery, endocrine pathology, and thyroidology, to-date22 Sengul D, Sengul I, Egrioglu E, Ozturk T, Aydın I, Kesicioglu T, et al. Can cut-off points of 10 and 15 mm of thyroid nodule predict malignancy on the basis of three diagnostic tools: i) strain elastography, ii) the Bethesda System for Reporting Thyroid Cytology with 27-gauge fine-needle, and iii) histopathology? J BUON. 2020;25(2):1122-9. PMID: 32521915. To this end, the cytopathologic evaluation of the cases had been performed based on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), 1st ed.44 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...
and our FNA cytology outcomes for nondiagnostic/unsatisfactory cytology were revealed as 9.0%22 Sengul D, Sengul I, Egrioglu E, Ozturk T, Aydın I, Kesicioglu T, et al. Can cut-off points of 10 and 15 mm of thyroid nodule predict malignancy on the basis of three diagnostic tools: i) strain elastography, ii) the Bethesda System for Reporting Thyroid Cytology with 27-gauge fine-needle, and iii) histopathology? J BUON. 2020;25(2):1122-9. PMID: 32521915. Moss et al.55 Moss WJ, Finegersh A, Pang J, Califano JA, Coffey CS, Orosco RK, et al. Needle biopsy of routine thyroid nodules should be performed using a capillary action technique with 24- to 27-gauge needles: a systematic review and meta-analysis. Thyroid. 2018;28(7):857-63. https://doi.org/10.1089/thy.2017.0643
https://doi.org/10.1089/thy.2017.0643...
reported in a systematic review and meta-analysis that the regular and coordinated thyroid FNA should be performed with smaller needle gauges, 24–27-gauges, without aspiration, routinely. In addition, we very recently introduced and suggested a novel terminology, in this sense, termed as “minimally invasive FNA; MIFNA” and “minimally invasive thyroid FNA; Thy MIFNA” involving 27-gauge fine-needle with topical and local anesthetic agents administration with the reasonable rates of nondiagnostic cytology, TBSRTC66 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.,77 Sengul I, Sengul D. Delicate needle with the finest gauge for a butterfly gland, the thyroid: is it worth mentioning? Sanamed. 2021;16(2):173-4. https://doi.org/10.24125/sanamed.v16i2.515
https://doi.org/10.24125/sanamed.v16i2.5...
.
Of note, we recommend opting for Thy MIFNA with 27-gauge fine-needle to practice US-FNA procedure for indicated suspicious thyroid nodules with reasonable low rates of Category I (TBSRTC, 1st and 2nd eds.) and probably low severity of pain. To this end, we also recommend wielding facilitating pre- or periprocedural local, even topical anesthetic agents toward US-FNA for the thyroid nodules22 Sengul D, Sengul I, Egrioglu E, Ozturk T, Aydın I, Kesicioglu T, et al. Can cut-off points of 10 and 15 mm of thyroid nodule predict malignancy on the basis of three diagnostic tools: i) strain elastography, ii) the Bethesda System for Reporting Thyroid Cytology with 27-gauge fine-needle, and iii) histopathology? J BUON. 2020;25(2):1122-9. PMID: 32521915,66 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.,77 Sengul I, Sengul D. Delicate needle with the finest gauge for a butterfly gland, the thyroid: is it worth mentioning? Sanamed. 2021;16(2):173-4. https://doi.org/10.24125/sanamed.v16i2.515
https://doi.org/10.24125/sanamed.v16i2.5...
. As a matter of fact, this issue merits further investigation.
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Funding: none.
ACKNOWLEDGMENTS
We thank all of the article participants.
REFERENCES
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1Tanaka A, Hirokawa M, Higuchi M, Kanematsu R, Suzuki A, Kuma S, et al. Optimal needle size for thyroid fine needle aspiration cytology. Endocr J. 2019;66(2):143-7. https://doi.org/10.1507/endocrj.EJ18-0422
» https://doi.org/10.1507/endocrj.EJ18-0422 -
2Sengul D, Sengul I, Egrioglu E, Ozturk T, Aydın I, Kesicioglu T, et al. Can cut-off points of 10 and 15 mm of thyroid nodule predict malignancy on the basis of three diagnostic tools: i) strain elastography, ii) the Bethesda System for Reporting Thyroid Cytology with 27-gauge fine-needle, and iii) histopathology? J BUON. 2020;25(2):1122-9. PMID: 32521915
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3Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. https://doi.org/10.1089/thy.2015.0020
» https://doi.org/10.1089/thy.2015.0020 -
4Cibas 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 -
5Moss WJ, Finegersh A, Pang J, Califano JA, Coffey CS, Orosco RK, et al. Needle biopsy of routine thyroid nodules should be performed using a capillary action technique with 24- to 27-gauge needles: a systematic review and meta-analysis. Thyroid. 2018;28(7):857-63. https://doi.org/10.1089/thy.2017.0643
» https://doi.org/10.1089/thy.2017.0643 -
6Sengul 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.
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7Sengul I, Sengul D. Delicate needle with the finest gauge for a butterfly gland, the thyroid: is it worth mentioning? Sanamed. 2021;16(2):173-4. https://doi.org/10.24125/sanamed.v16i2.515
» https://doi.org/10.24125/sanamed.v16i2.515
Publication Dates
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Publication in this collection
19 Nov 2021 -
Date of issue
Sept 2021
History
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Received
14 July 2021 -
Accepted
18 July 2021