Big gain, no pain: Thyroid minimally invasive FNA (Thy MIFNA): Proposal of novelty in terminology

In the field of thyroidology, image-guided interventional procedures have globally been discerned and incrementally utilized over the past four decades. While ultrasonography (US) and fine-needle aspiration (FNA) serve as a diagnostic cornerstone to rule out malignancy in thyroid lesions, per se, remaining the main challenge in their management, to a lesser extent, core needle biopsy has been being currently used as another primary diagnostic tool for evaluating this crucial issue. Nevertheless, the debate is still ongoing, and in particular, indeterminate cytology remains to be a highly controversial issue in thyroid cytopathology, a dynamic discipline, to date¹–³. To deal with this compelling state and resolve this issue, clinical data, sonographic features, elastographic pattern, or outcome of other imaging/interventional techniques should be considered together and also can be supported by the relevant molecular testing. Roles of sonography and FNA are well-established and well-accepted in the diagnosis of thyroid nodules worldwide. However, to the best of our knowledge, the ideal needle size for US-guided FNA (henceforward, FNA) procedure has not been declared in a released well-accepted management guideline, up to now. On the contrary, a wide range of needle sizes, 20–27 gauge (G), have been used for application in the different geographic regions (e.g., 25–27-G in most Western countries and 21–22-G in Japan)⁴. Adequacy of the finer and thicker needles has been reported as similar by many authors⁵. Hanbidge et al.⁶ proclaimed no significance between the 23- and 27-G needles in the adequacy of the samples obtained. Of note, the authors asserted that the diagnostic quality of the aspirate may be preferable to the finer one, harboring 27-G⁶. Zhang et al.⁷ stated that no statistically significant differences were present between 23-, 25-, and 27-G needles with the adequacy rates (88.5, 90.4, and 89.7%, respectively; p>0.05), involving higher numerical rates in 27-G needle than the 23-G one. However, Tanaka et al.⁸ reported that the nondiagnostic/unsatisfactory rates of 22- and 25-G needles were 18.5 and 21.0%, respectively. We have utilized the 27-G needles for our interventional US techniques with surgeon-performed US (SUS) for 10 years, which have been performed by one endocrine surgery sonographer (I.S.), with the nondiagnostic cytology (Category I, The Bethesda System for Reporting Thyroid Cytopathology [TBSRTC], 1st ed.) rate of 9.0%³–⁹. On the other hand, the size/bore of the fine needle for FNA application might also affect the comfort of the patient. The real adequate and comfortable sampling technique with less painful instruments in the case of interventional procedures might be considered as state-of-the-art. “Bonitas non est pessimis esse meliorem.” Herewith, we might propound to opt for a 27-G needle for aspiration purposes as an efficient and comfortable tool of choice. In addition, we have administrated preprocedural local anesthesia to the neck region of the cases before the “SUS-based” FNA during the time frame of 10 years. We even have administrated topical anesthesia before administrating the preprocedural local anesthetic agent during the mentioned decade. Currently, on the basis of the scientific reports in the English-language literature and our experiences, we have presented and kindly propounded a novel term, “minimally invasive FNA” (MIFNA) and “Thyroid minimally invasive FNA” (Thy MIFNA)¹⁰,¹¹. More recently, we suggested opting for Thy MIFNA with 27-G fine needle in FNA while revisiting optimal needle size for thyroid FNA cytology in terms of diagnostic rate and comfort of the patient as different pears in a pod, which has currently been published in Volume 67, Revista da Associação Médica Brasileira¹². We hope Thy MIFNA¹⁰–¹², involving preprocedural topical and local anesthesia with 27-G genuine fine needle, to contribute considerably in the field of neck-endocrine and endocrine surgery, endocrinology, endocrine pathology, interventional radiology, head & neck surgery, otorhinolaryngology, and thyroidology as a delicate¹⁰–¹² and crucial diagnostic tool with a novel terminology.

• Funding: none.

ACKNOWLEDGMENTS

The authors thank all the participants of the article.

REFERENCES

• ¹
  Sengul D, Sengul I, Pelikán A. Paraphrase for the impact of repeat fine-needle aspiration in thyroid nodules categorized as atypia of undetermined significance or follicular lesion of undetermined significance: a single center experience. Diagn Cytopathol. 2021;49(3):452-3. https://doi.org/10.1002/dc.24685
  » https://doi.org/10.1002/dc.24685
• ²
  Sengul I, Sengul D. Focusing on thyroid nodules in suspense: 10-15 mm with repeat cytology, Category III, the Bethesda System for Reporting Thyroid Cytopathology, TBSRTC. Rev Assoc Med Bras (1992). 2021;67(2):166-7. https://doi.org/10.1590/1806-9282.67.02.20200828
  » https://doi.org/10.1590/1806-9282.67.02.20200828
• ³
  Sengul D, Sengul I, Van Slycke S. Risk stratification of the thyroid nodule with Bethesda indeterminate cytology, category III, IV, V on the one surgeon-performed US-guided fine-needle aspiration with 27-gauge needle, verified by histopathology of thyroidectomy: the additional value of one surgeon-performed elastography. Acta Chir Belg. 2019;119(1):38-46. https://doi.org/10.1080/00015458.2018.1551769
  » https://doi.org/10.1080/00015458.2018.1551769
• ⁴
  Maeda H, Kutomi G, Satomi F, Shima H, Mori M, Hirata K, et al. Clinicopathological characteristics of thyroid cancer misdiagnosed by fine needle aspiration. Exp Ther Med. 2016;12(4):2766-72. https://doi.org/10.3892/etm.2016.3651
  » https://doi.org/10.3892/etm.2016.3651
• ⁵
  Cerit M, Yücel C, Göçün PU, Poyraz A, Cerit ET, Taneri F. Ultrasound-guided thyroid nodule fine-needle biopsies--comparison of sample adequacy with different sampling techniques, different needle sizes, and with/without onsite cytological analysis. Endokrynol Pol. 2015;66(4):295-300. https://doi.org/10.5603/EP.2015.0037
  » https://doi.org/10.5603/EP.2015.0037
• ⁶
  Hanbidge AE, Arenson AM, Shaw PA, Szalai JP, Hamilton PA, Leonhardt C. Needle size and sample adequacy in ultrasound-guided biopsy of thyroid nodules. Can Assoc Radiol J. 1995;46(3):199-201. PMID: 7538881
• ⁷
  Zhang L, Liu Y, Tan X, Liu X, Zhang H, Qian L. Comparison of different-gauge needles for fine-needle aspiration biopsy of thyroid nodules. J Ultrasound Med. 2018;37(7):1713-6. https://doi.org/10.1002/jum.14521
  » https://doi.org/10.1002/jum.14521
• ⁸
  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
• ⁹
  Sengul D, Sengul I, Egrioglu E, Ozturk T, Aydin 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
• ¹⁰
  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
• ¹¹
  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
• ¹²
  Sengul I, Sengul D, Veiga ECA. Revisiting optimal needle size for thyroid fine-needle aspiration cytology: not much finer, less non-diagnostic? Rev Assoc Med Bras (1992). 2021;67(9):1213-4. https://doi.org/10.1590/1806-9282.20210671
  » https://doi.org/10.1590/1806-9282.20210671

Publication Dates

• Publication in this collection
  13 Dec 2021
• Date of issue
  Dec 2021

History

• Received
  18 Sept 2021
• Accepted
  20 Sept 2021