Revisiting optimal needle size for thyroid fine-needle aspiration cytology: not much finer, less non-diagnostic?

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 cytology¹.” Tanaka et al.¹ 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) histopathology². 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 months²,³. 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-date². To this end, the cytopathologic evaluation of the cases had been performed based on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), 1st ed.⁴ and our FNA cytology outcomes for nondiagnostic/unsatisfactory cytology were revealed as 9.0%². Moss et al.⁵ 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, TBSRTC⁶,⁷.

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 nodules²,⁶,⁷. As a matter of fact, this issue merits further investigation.

• Funding: none.

ACKNOWLEDGMENTS

We thank all of the article participants.

REFERENCES

• ¹
  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.EJ18-0422
• ²
  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
• ³
  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
• ⁴
  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
• ⁵
  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
• ⁶
  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.
• ⁷
  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.v16i2.515

Publication Dates

• Publication in this collection
  19 Nov 2021
• Date of issue
  Sept 2021

History

• Received
  14 July 2021
• Accepted
  18 July 2021