Hermeneutics for Evaluation of the Diagnostic Value of Ultrasound Elastography in TIRADS 4 Categories of Thyroid Nodules

Abstract

The accurate size cutoff of thyroid nodules for interventional diagnostic purposes still remains a major challenge in Thyroidology like thyroid nodules with indeterminate cytology and/or suspicious sonography, to date. The size cutoff of 10 mm has been well-stablished by recommendations of some guidelines for the thyroid nodules for the purposes of US-guided fine-needle aspiration (US-FNA). Nevertheless, some authors emphasized the “epidemic” of papillary thyroid carcinoma under 10 mm in the largest diameter of the thyroid nodules. In addition, The American Thyroid Association, ATA, Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer recommended US-FNA procedure for thyroid nodules under 5 mm in case of simultaneous existence of lateral cervical lymph node (LCLN) metastasis. Herein, some authors consider the size cutoff of 5 mm for developing LCLN metastases and extrathyroidal extensions. Of note, LCLN metastasis is reported as being more closely observed in papillary thyroid microcarcinomas ≥7 mm than in those under 7 mm. Furthermore, some other studies stated the size cutoff of >7 mm or 8 mm as an independent factor for LCLN metastasis. Herewith, we postulate that so-called thyroid nodules under 10 mm concept selectively might enrich accurate diagnostic purposes of malignancies in Thyroidology.