Comment on reevaluation of malignancy risk in nondiagnostic thyroid nodules with long‐term follow‐up via surgical resection or core needle biopsy thyroidology

The retrospective cohort study by Jeong et al., 1 published in the December 2025 Cancer Cytopathology , provides a timely and critical reevaluation of the risk of malignancy (ROM) in nondiagnostic thyroid nodules for thyroidologists. By integrating long - term follow - up data from both surgical resection and core needle biopsy (CNB), the authors suggest a pragmatic solution to the long - standing issue of selection bias, which has historically inflated ROM estimates in Category I of The Bethesda System for Reporting Thyroid Cytopa-thology (TBSRTC). A significant contribution of this work is the demonstration that ROM estimates derived exclusively from surgical specimens (reaching 54.1% in this cohort) significantly overestimate the actual risk, compared with the integrated ROM range of 5.0% to 17.7%. This refined spectrum not only aligns with the 2023 TBSRTC update 2–4 but also provides a more robust evidentiary basis for clinical decision - making. As such, the findings offer that the historical “nondiagnostic” label should no longer be viewed as an immediate harbinger of malignancy, but rather as a diagnostic gap that can be effectively bridged. Additionally, the study’s identification of younger age, spiculated margins, and hypoechogenicity as independent predictors of malignancy is particularly salient, as these markers allow for a shift from a uniform repeat - biopsy interval to a more nuanced, risk - stratified surveillance strategy. Furthermore, the evidence regarding CNB’s diagnostic superiority over repeat fine - needle aspiration 5 is compelling. By preserving histomorphological architecture and the lesion–parenchyma interface, CNB effectively attenuates the rate of persistent nondiagnostic results, which the authors show to be as high as 36.5% with repeat