A closer look at the size cutoff of 10 mm, below 10 mm in particular, in thyroidology: debate is still ongoing

Abstract

To date, the size cutoff of 10, 15, and 20 mm has been one of the most challenging issues in endocrine pathology, endocrine surgery, endocrinology, head and neck surgery, head and neck radiology, and thyroidology. Of note, the size cutoff of 10 mm particularly remains crucial in the evaluation and management of thyroid nodules with suspicious clinical findings, sonographic features, and/or cytology [1][2][3][4] .More recently, Borges et al. 5 reported a valued research article, entitled "Thyroid nodules 1 cm or less are related to Bethesda System nondiagnostic and suspicious for malignancy categories." In terms of the size cutoff of 10 mm, they sought to investigate the fine-needle aspiration (FNA) cytology of the nodules below and above 10 mm. They had analyzed 3,703 nodules, had undergone FNA during January 2016 to December 2019, and declared the size cutoff ≤10 mm was associated with cytology of nondiagnostic/unsatisfactory (prevalence ratio [PR]: 3.0, 95%CI 2.2-4.2) and suspicious of malignancy (PR: 1.6, 95%CI 1.1-2.4) for Categories I and V, secunda edition, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), respectively 5 . It is important to note that the size cutoff of 10 mm, per se, has been set as not being underestimated gauge by some recommendations on the size selection criteria for the thyroid nodule, that is, FNA is recommended for the nodules:1. Above 10 mm, solid and hypoechoic on ultrasound, the American Association of Clinical Endocrinologists (AACE)/Asociazione Medici Endocrinologi (Italian Association of Clinical Endocrinologists or AME) (Grade B; best evidence level [BEL] 3); 2. >10 mm, high-risk category, the novel European Thyroid Imaging and Reporting Data System

Is the neutrophil-to-lymphocyte "ratio"nale from head and neck to thyroidology for thyroidologists?: promise or passé?

“…This research of high quality seems to demand portraying to evaluation of the effect of the neutrophil-to-lymphocyte ratio (N/L) on distinguishing benign from malignant masses in the submandibular triangle of the head and neck which has recently been published in the 69th volume of Rev Assoc Med Bras 1 . The author stated that he retrospectively evaluated 48 cases who had undergone surgery for submandibular gland masses with the histopathology of sialolithiasis, sialadenitis, pleomorphic adenoma 2 – 4 , and malignant conditions. He deduced and emphasized that N/L, per se , can be used as a biomarker in submandibular gland masses and has prognostic significance in malignant masses.…”