Subcentimeter thyroid nodules: Diagnostic challenges, risk stratification and management in contemporary surgical...

Subcentimeter thyroid nodules, defined as those measuring less than 10 mm in maximum diameter, represent a growing diagnostic and surgical oncology challenge. The proliferation of neck ultrasonography has dramatically increased their incidental detection, yet existing risk stratification systems were validated predominantly in larger nodule cohorts. This is a narrative review of contemporary evidence, incorporating data from the ElaTION randomised controlled trial, the recent 2026 BTA/BAETS Joint Consensus Statement, and service-level analyses from a single UK centre, to evaluate the diagnostic performance, risk stratification and optimal management of subcentimeter thyroid nodules. Paradoxically, referred nodules under 10 mm carry a malignancy rate of 38.3% - exceeding larger nodules - reflecting selection enrichment in the investigated cohort. Nevertheless, the majority of thyroid microcarcinomas are clinically indolent, and former BTA guidance has driven disproportionate fine-needle aspiration cytology (FNAC) and surgical activity without commensurate diagnostic yield. The 2026 BTA/BAETS consensus introduces size-stratified FNAC thresholds and removes vascularity as a primary risk stratification feature, aligning UK practice with international TIRADS approaches.