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How important is on-site adequacy assessment for thyroid FNA? An evaluation of 883 cases
Weijian Zhu1, Claire W Michael
1Department of Pathology, University of Michigan Hospitals, Ann Arbor, MI 48109-0054, USA.
Insights
Immediate adequacy assessment (IADA) in thyroid fine-needle aspiration (FNA) significantly reduces nondiagnostic rates (NDR). Optimal sample adequacy is achieved with 4-6 passes, improving diagnostic yield and patient outcomes.
Area of Science:
- Cytopathology
- Endocrinology
- Surgical Pathology
Background:
- Immediate adequacy assessment (IADA) is not universally applied during thyroid fine-needle aspiration (FNA).
- The optimal number of passes for thyroid FNA to minimize nondiagnostic rates (NDR) is not well-established.
- Variability in FNA techniques can impact diagnostic accuracy and subsequent patient management.
Purpose of the Study:
- To evaluate the impact of IADA on NDR in thyroid FNA specimens.
- To determine the optimal number of passes required for adequate thyroid FNA samples.
- To assess the diagnostic yield of follow-up procedures for nondiagnostic thyroid FNAs.
Main Methods:
- Retrospective analysis of 883 thyroid FNA specimens (January 2001-December 2003).
- Comparison of NDR between FNAs performed with and without IADA.
- Evaluation of cytological and surgical follow-up for nondiagnostic cases.
- Analysis of NDR in relation to the number of FNA passes.
Main Results:
- NDR was significantly lower with IADA (5.9%) compared to without IADA (31.8%).
- The optimal number of passes for minimizing NDR was determined to be 4-6 passes.
- Follow-up of nondiagnostic cases without IADA revealed a higher rate of missed malignancies (13.8%) compared to those with IADA.
Conclusions:
- IADA significantly reduces NDR and improves sample adequacy for thyroid FNA diagnosis.
- Performing 4-6 passes is optimal for thyroid FNA, with diminishing returns for additional passes.
- Close follow-up of nondiagnostic thyroid FNAs, particularly those without IADA, is crucial to avoid missed diagnoses.
Abstract:
Immediate adequacy assessment (IADA) during fine-needle aspiration (FNA) is not universal and the optimal number of passes has not been well determined. The aim of this study was to evaluate the nondiagnostic rates (NDR) with and without the IADA forthyroid aspirates. Subsequent cytological and surgical follow-up were reviewed for non-diagnostic cases. In addition, we evaluated the number of passes performed in each FNA to determine the optimal number. Retrospective analysis of NDR was performed on 883 thyroid FNA specimens retrieved through a Computer SNOMED Search from our files between January 2001 to December 2003. For FNAs with IADA, one Diff-Quick and one fixed smear for each pass were prepared, and the needle was rinsed in CytoLyt solution for a ThinPrep and/or a cell-block. FNAs without IADAwere received in CytoLyt solution, from which a ThinPrep and a cell-block were prepared for each case. Of the total 883 cases, 443 were performed with IADA, of which 417 cases were diagnostic. The remaining 440 cases were performed without IADA, of which 300 cases were diagnostic.NDR for IADA was 5.9% (26 cases-group-I)compared to 31.8% (140 cases-group-II)without IADA. In group-I, 5 cases were followed-up by repeat FNA, 10 cases by surgical resection, and 11 cases received no tissue follow-up. In group-II, 23 cases were followed-up by repeat FNA, 36 by surgical resection, and 82 cases received no tissue follow-up. Interestingly, follow-up in group-I did not reveal any missed malignancy, while that in group-II resulted in a malignant diagnosis in 13.8% (8 cases). We also found that the optimal number of passes with least NDR was 4-6 passes.NDR was 25% for < 3 passes, 11% for 4 passes, 5.2% for 5 passes, 1.4% for 6 passes, and 2.5% for 7 passesor more. IADA significantly reduces the NDR and increases the sample adequacy for diagnosis. Optimal number of passes is 4-6 passes, and additional passes did not improve the diagnostic rate. Our study also emphasizes the significance of repeat FNA or histological follow-up for nondiagnostic cases, especially for those without IADA.
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