Sengul, Demet

Sengul, Ilker

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Comments: Effect of the location and size of thyroidnodules on the diagnostic performance of ultra-sound elastography: A retrospective analysisDemet Sengul0000-0000-0000-0000 ,I,* Ilker Sengul0000-0000-0000-0000 II,IIIIDepartment of Pathology, Giresun University Faculty of Medicine, 28100 Giresun, Turkey. IIDivision of Endocrine Surgery, Giresun University Faculty ofMedicine, 28100 Giresun, Turkey. IIIDepartment of General Surgery, Giresun University Faculty of Medicine, 28100 Giresun, Turkey.Sengul D, Sengul I. Comments: Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography:A retrospective analysis. Clinics (Sao Paulo). 2021;76:e2891*Corresponding author. E-mail: demet.sengul.52@gmail.comWe read with great interest the research article entitled‘‘Effect of the location and size of thyroid nodules on thediagnostic performance of ultrasound elastography: A retro-spective analysis’’ by Xie and Yu (1). The authors claimedthat the results of strain ultrasound elastography should becarefully evaluated when small thyroid nodules are close tothe carotid artery. They indicated that the use of cytology todetermine nodule parameters is effective in determining thediagnostic ability of strain ultrasound elastography. How-ever, they discussed only benign and suspicious nodulesthroughout their article.According to the Bethesda System for Reporting ThyroidCytopathology (TBSRTC), 1st ed., the risk of malignancy(ROM) from indeterminate cytology is as follows: III, atypiaof undetermined significance or follicular lesion of undeter-mined significance (AUS/FLUS), 5% 15%; IV, follicularneoplasm (FN) or suspicious for a follicular neoplasm (SFN),15% 30%; and V, suspicious for malignancy (SM), 60%75%, while in the TBSRTC 2nd ed., the ROMs are 10% 30%,25% 40%, and 50% 75%, respectively.The leading thyroid cytology classification systems havecategorized indeterminate cytology and their associated ROMsinto categories equivalent to III, IV, and V of the TBSRTC.The current 2016 UK Royal College of Pathologists(RCPath) Thy terminology divides the indeterminate cytol-ogy category Thy3 into Thy3a, neoplasm possible, atypia/nondiagnostic, and Thy3f, neoplasm possible, suggestive ofFN, with ROMs of 20% 31%, and 24% 39%, respectively,and defines Thy4 as SM with a ROM of 70% 87%.The 2014 Italian Consensus for the Classification andReporting of Thyroid Cytology (ICCRTC) divided its diag-nostic category TIR3, indeterminate cytology, into two sub-categories: TIR3A (low-risk indeterminate lesion, LRIL) andTIR3B (high-risk indeterminate lesion, HRIL), with differentexpected cancer risks and discrete clinical characteristics.TIR3A is characterized by augmented cellularity with numer-ous microfollicular structures in a low colloid background or ascarce cellular structure consisting predominantly of micro-follicular groups with oxyphilic features (Hurthle cells), withan expected cancer risk of o10%. TIR3B is characterized bymild/focal nuclear atypia, with an expected cancer risk of20% 30%. The ICCRTC also includes category TIR4, SMwith an expected malignancy risk of 60% 80%.The 2014 Royal College of Pathologists of Australasia(RCPA) and Australian Society of Cytology (ASC) categor-ized thyroid nodules as follows: 3, indeterminate (AUS/FLUS) with a low ROM of 5% 13%; 4, suggestive of an FN(FN/SFN) with a moderate ROM of 21% 26%; and 5, SMwith a high ROM of 85% 90%.The 2013 Japan Thyroid Association (JTA) Guidelines for theManagement of Thyroid Nodules categories are as follows:indeterminate B, other tumors, (TBSTRC III); indeterminate A,FN, (TBSRTC IV), i) indeterminate A1, favor benign, ii)indeterminate A2, borderline, iii) indeterminate A3, favormalignant; and SM (TBSRTC V).In addition, the first one remains a crucial challenging cyto-logical category in all systems. Category I in TBSRTC, 1st and2nd ed., is Nondiagnostic or Unsatisfactory. Category Thy1 inthe 2016 RCPath is Nondiagnostic for cytological diagnosis andThy1c is Nondiagnostic for cytological diagnosis–cystic lesion.Category TIR1 in the 2014 ICCRTC/Italian Society for Anato-mic Pathology and Cytology Italian Thyroid Association(SIAPEC-AIT2013) is Nondiagnostic and TIR1c is Nondiag-nostic cystic. Category 1 in the 2014 RCPA/ASC is Non-diagnostic, and Category 1 in the 2013 JTA is Inadequate. Thesecategories are still used in the management of suspicious(not just indeterminate cytology) nodules (2-7). Therefore, asuspicious nodule may be classified as AUS/FLUS, FN/SFN,SM, and even as nondiagnostic, all of which have a wide rangeof ROMs. Is it important to point out the cytological categories ofthe thyroid nodules in the research by Xie and Yu? Hasdesignating the nodules as ‘‘suspicious’’, while ICCRTC dividedTIR3, indeterminate cytology, into A, LRIL and B, HRIL (eventhough the latter corresponds to TBSRTC IV unlike the former)and even sub-typing TBSRTC III is being discussed, nowadays,by some authors, affected their results? This issue merits furtherinvestigation. We thank Xie and Yu for their valuable study.’ REFERENCES1. Xie X, Yu Y. Effect of the location and size of thyroid nodules on thediagnostic performance of ultrasound elastography: A retrospectiveDOI: 10.6061/clinics/2021/e2891Copyright & 2021 CLINICS – This is an Open Access article distributed under theterms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in anymedium or format, provided the original work is properly cited.No potential conflict of interest was reported.1COMMENTSanalysis. Clinics (Sao Paulo). 2020;75:e1720. https://doi.org/10.6061/clinics/2020/e17202. Sengul D, Sengul I. Association between Tsukuba elasticity scores 4 and 5on elastography and Bethesda undetermined cytology on US-guidedFNA with 27-G needle, verified by histopathology: a cut-off point of20 mm of diameter designated for thyroid nodules. J BUON. 2019;24(1):382-90.3. Sengul D, Sengul I, Van Slycke S. Risk stratification of the thyroid nodulewith Bethesda indeterminate cytology, category III, IV, V on the one sur-geon-performed US-guided fine-needle aspiration with 27-gauge needle,verified by histopathology of thyroidectomy: the additional value of onesurgeon-performed elastography. Acta Chir Belg. 2019;119(1):38-46.https://doi.org/10.1080/00015458.2018.15517694. Sengul D, Sengul I, Pelikán A. Paraphrase for the impact of repeatfine-needle aspiration in thyroid nodules categorized as atypia ofundetermined significance or follicular lesion of undetermined sig-nificance: A single center experience. Diagn Cytopathol. 2021;49(3):452-3.https://doi.org/10.1002/dc.246855. Nardi F, Basolo F, Crescenzi A, Fadda G, Frasoldati A, Orlandi F, et al.Italian consensus for the classification and reporting of thyroid cytology.J Endocrinol Invest. 2014;37(6):593-9. https://doi.org/10.1007/s40618-014-0062-06. Nga ME, Kumarasinghe MP, Tie B, Sterrett GF, Wood B, Walsh J, et al.Experience with standardized thyroid fine-needle aspiration reportingcategories: follow-up data from 529 cases with ‘‘indeterminate’’ or ‘‘aty-pical’’ reports. Cancer Cytopathol. 2010;118(6):423-33. https://doi.org/10.1002/cncy.201117. Kakudo K, Kameyama K, Miyauchi A. History of Thyroid Cytology inJapan and Reporting System Recommended by the Japan Thyroid Asso-ciation. J Basic Clin Med. 2013;2(2):10-5.2Indeterminate cytologySengul D. & Sengul I.CLINICS 2021;76:e2891

Comments: Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography: A retrospective analysis

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Comments: Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography: A retrospective analysis

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