A consideration of the trends in thyroid fine-needle aspiration cytology – Results from the Italian Cytopathology Committee National Practice Survey in Thyroidology

Dear Editor

It is with the utmost deference and profound interest that we peruse the recent contribution to these pages by Acanfora et al.¹, which offers a most valuable aperçu of the current state of thyroid fine-needle aspiration (FNA) cytology practice across the Italian peninsula in thyroidology. The authors are to be commended for their diligent undertaking, which illuminated several salient points of contemporary practice, particularly in the context of the Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC). This survey, being a work of no small relevance, shall surely serve as a critical datum for future considerations.

The finding that the volume of thyroid FNAs returned to pre-pandemic levels by the year 2022 is indeed a welcome sign of the restoration of clinical normalcy, and the widespread adoption of the ICCRTC system (90.4%) speaks volumes to the success of national standardization efforts. Such uniformity in reporting is, without question, a cornerstone of robust inter-institutional communication and patient care. Yet, a careful examination of the reported data prompts a gentle query regarding specific procedural nuances. The observation that the majority of FNAs (75%) are performed by non-pathologist physicians – chiefly endocrinologists and radiologists – is a point of interest. While the skill and dedication of these clinicians are not to be underestimated, the established literature suggests that the immediate presence of a cytopathologist for rapid on-site evaluation (ROSE) can significantly enhance specimen adequacy and diagnostic yield. One might, therefore, consider the potential for further optimization of the pre-analytical phase, perhaps through enhanced collaborative models that more closely integrate the proceduralist and the diagnostic cytologist, a matter of no slight consequence for patient management.