Comments on "Accuracy of ultrasound-guided fine-needle aspiration cytology in evaluation of thyroid nodules using different ultrasonographic and cytological features"

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Dear Editor,

Ab initio, disorders and therapeutic options for the delicate papillon gland, the thyroid, have been a dynamic discipline that may demand a gracious approach from human beings in thyroidology^ 1-5 ^. We have read with a great deal the research article of Al-Yousofy et al.^ 6 ^ entitled "Accuracy of ultrasound-guided fine-needle aspiration cytology in evaluation of thyroid nodules using different ultrasonographic and cytological features." This utilitarian research seems to demand a determination of the efficacy of the ultrasonography (US)-guided fine-needle aspiration (FNA) cytology in 212 cases during 7 years, using cytologic and sonographic features. Al-Yousofy et al.^ 6 ^ declared in their study the significant US features that favor malignancy, such as hypoechogenicity, mixed echogenicity, irregular border, microcalcification, and rim halo. In addition, the authors emphasized a significant difference between different categories of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Somewhat apart, they laid stress on the cytologic features compliant with malignancy, such as grooving, nuclear irregularities, nuclear pseudoinclusion, and little colloid. Nevertheless, a wide range of needle sizes, 20–27 Gauge (G), have been used for FNA applications prior to cytologic evaluations in different geographic regions worldwide: 25–27 G in most West and 21–22 G in the Middle East^ 7-10 ^. We mentioned Category III, TBSRTC, 3rd edition, from another perspective in Revista da Associação Médica Brasileira, 67th volume, second issue^ 11 ^. Furthermore, we reported whether it is essential to maintain Category III, anticipated TBSRTC, inevitable 3rd edition, as an indivisible category within indeterminate cytology or not, which was published in Revista da Associação Médica Brasileira, 67th volume, tenth issue^ 12 ^ prior to the current edition of this lexicon, the 2023 TBSRTC by Ali et al.^ 13 ^ published in Thyroid, which has been announced after two former successful editions by Cibas et al.^ 14,15 ^ Finally, we have recommended working with subsets to resolve the ongoing debate on "indeterminate cytology," similar to "intermediate suspicion" in radiology^ 16 ^. As such, would the utilization of thicker or finer needles alter^ 3-5 ^ the outcome(s) of this study? Furthermore, would putting topical and/or local anesthetic agents alongside this interventional procedure move on^ 1,3,7,9,10 ^ the denouement(s) of this work? Moreover, would an implementable germaneness of both novel subgroups of Category III, TBSRTC, 3rd edition, convert or modify^ 4,11,12,16 ^ the corollary of this study? This issue merits further investigation. We thank Al-Yousofy et al.^ 6 ^ for their valuable study in thyroidology.