Bellevue, Oliver1; Perez-Reyes, Nuria2; Hamilton, Stephanie2; Robin, Jeff3; Sniezek, Joseph4
1 General Surgery Residency, Swedish Medical Center, Seattle, WA, USA
2 Cellnetix Pathology and Laboratories, Seattle, WA, USA
3 Department of Head and Neck Surgery, Swedish Medical Center, Seattle, WA, USA
4 Medical Director of Head and Neck Endocrine Surgery, Swedish Medical Center, Seattle, WA, USA
Background/Purpose: The rate of nondiagnostic thyroid fine needle aspiration (FNA) is reported between 3-35% (1-5) and ideally is less than 10% (6).
Objectives: To determine if FNA samples that are obtained by a clinician and immediately reviewed on-site are associated with a lower rate of nondiagnostic results.
Methods: We performed a retrospective chart review of ultrasound-guided FNAs obtained by a single otolaryngologist which underwent immediate on-site review and compared these results to all ultrasound-guided FNAs (generated by non-clinicians without on-site review) over a 30-month period (July 1, 2014 to December 31, 2016) at a single institution. Results were stratified by Bethesda category. Groups were compared using a standard chi-squared statistical test.
Results: A total of 8,433 FNAs were completed over the study period, of which 262 were obtained by the aforementioned clinician. The clinician-performed samples resulted in lower rates of nondiagnostic samples (5.7% v 13.1%, p = 0.0002) and higher rates of malignant diagnosis (7.6% v 3.3%, p = 0.0008). Rates of benign lesions (71.0% v 67.7%, p = 0.28), atypical or follicular lesions of undetermined significance (11.1% v 12.5%, p = 0.57), follicular neoplasms (3.1% v 1.6%, p = 0.09), and lesions suspicious for malignancy (1.5% v 1.6%, p = 0.80) were statistically similar between groups.
Discussion & Conclusion: Immediate review of thyroid FNA samples has been shown to improve diagnostic yield (1,3-4). FNAs that are obtained by surgeons and undergo on-site review correlate with a reduction in diagnostic ambiguity.