Background: Benign (TBN) and malignant (TMN) thyroid nodules are a common thyroid lesion. The differentiation of TMN often remains a clinical challenge and further improvements of TMN diagnostic accuracy are warranted. The aim of this study is to evaluate the possibilities of using differences in trace element contents (TEs) in nodular tissue to diagnose thyroid malignancies and to determine the sensitivity, specificity, and accuracy for most informative TEs in the diagnosis of TMN. Methods: Contents of TEs such as bromine (Br), copper (Cu), iron (Fe), iodine (I), rubidium (Rb), strontium (Sr), and zinc (Zn) were prospectively evaluated in “normal” thyroid (NT) of 105 individuals as well as in nodular tissue of thyroids with TBN (79 patients) and to TMN (41 patients). Measurements were performed using energy-dispersive X-ray fluorescent analysis. Results: It was observed that in TMN tissue the mean mass fractions of I and Zn were lower while the mean mass fraction of Rb was higher than in NT and TBN tissue. It was demonstrated that the I contents is nodular tissue is the most informative parameter for the diagnosis of thyroid malignancy. It was found that “Sensitivity”, “Specificity” and “Accuracy” of TMN identification using the I level in the needle biopsy of affected thyroid tissue (87±5%, 96±2% and 94±2% respectively) were significantly higher than that made using ultrasound screening and cytological test of fine needle aspiration biopsy. Conclusions: It was concluded that determination the I level in a needle biopsy of TNs using energy-dispersive X-ray fluorescent analysis, is a fast, reliable, and informative diagnostic tool that can be successfully used as an additional test of thyroid malignancy identification. Peer Review History: Received: 11 March 2022; Revised: 9 April; Accepted: 28 April, Available online: 15 May 2022 Academic Editor: Dr. Emmanuel O. Olorunsola, Department of Pharmaceutics & Pharmaceutical Technology, University of Uyo, Nigeria, olorunsolaeo@yahoo.com UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Dr. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.yeDr. U. S. Mahadeva Rao, Universiti Sultan Zainal Abidin, Terengganu Malaysia, raousm@gmail.com
