Abstract

Fine-needle aspiration cytology (FNAC) remains the cornerstone of thyroid nodule evaluation, offering a minimally invasive, cost effective, and reliable diagnostic approach. Over the past decade, evolving evidence has reshaped its role in risk stratification, surgical planning, and integration with molecular diagnostics. The American Thyroid Association (ATA) 2025 Guidelines herald a transformative change, emphasizing risk-adapted thresholds, selective biopsy, and patient-centered care. Compared with the ATA 2015 Guidelines, the updated recommendations underscore the importance of ultrasound-based risk stratification, molecular testing, and avoidance of overdiagnosis. This article reviews the historical evolution of FNAC, outlines key updates in the ATA 2025 Guidelines, and discusses clinical implications, challenges in resource-limited settings, and future directions. FNAC remains a cornerstone of thyroid cancer management, yet its application today is increasingly refined, calling for consistency with guideline recommendations and responsiveness to local healthcare realities.

Key words: Thyroid cancer, Fine-needle aspiration cytology (FNAC), American Thyroid Association (ATA) Guidelines 2025, Bethesda System for Reporting Thyroid Cytopathology