Improvement of diagnostic performance of pathologists by reducing the number of pathologists responsible for thyroid fine needle aspiration cytology: An institutional experience

Seok, Jae Yeon; An, Jungsuk; Cho, Hyun Yee

doi:10.1002/dc.23893

Cited by 4 publications

(3 citation statements)

References 19 publications

(19 reference statements)

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“…In this regard, Hashimoto's thyroiditis seems to be one of the most common reasons for FP calls 45,46 . Seok et al 47 suggested that reducing the number of pathologists responsible for thyroid cytopathology leads to improved diagnostic accuracy, including the lowering of FP cases.…”

Section: Discussionmentioning

confidence: 99%

False positive cases in thyroid cytopathology – the experience of a single laboratory and a systematic review

et al. 2021

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Introduction Fine needle aspiration (FNA) is fundamental in the pre‐operative assessment of thyroid nodules. However, the shining success of thyroid FNA is occasionally eclipsed by false positive (FP) cytological diagnoses. We describe our experience regarding FP cytological diagnoses and present a literature review concerning FP rates. Materials and methods We retrospectively analyzed 2031 consecutive cytology reports. FP was defined as a case with “suspicious for malignancy” or “malignant” cytology, whose surgical follow‐up failed to confirm the initial diagnosis of malignancy. We used the PubMed database for the literature review using specific search terms (“thyroid”, “cytology”, “false positive”). Results Out of 2031 FNA reports, 93 cases with “suspicious for malignancy” or “malignant” cytology underwent surgical excision. Histopathology did not confirm malignancy in 10 cases (0.6% FP rate). Nodules with FP cytology were significantly larger (P = 0.0024) than those with with TP (true positive) cytology. A review of 25 publications shows comparable results to ours with some slight differences. The majority of studies achieve a FP rate below 3%. Most FP cytological diagnoses turn out to be non‐neoplastic lesions (nodular hyperplasia, adenomatous nodule, lymphocytic thyroiditis), which combined account for 80.5% of all histological diagnoses. Conclusions Thyroid nodules with FP cytology were larger than nodules with TP cytology. Most studies manage to adhere to the recommended FP rates, or values close to them, with some outliers. Nevertheless, the mean FP rate values are very close to the value recommended by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The FP rate value depends on how one defines true negative cases, which can be either histologically proven benign cases, via a benign clinical course, or by assuming that cytologically benign cases remain as such.

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Section: Discussionmentioning

confidence: 99%

False positive cases in thyroid cytopathology – the experience of a single laboratory and a systematic review

et al. 2021

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“…In a study in which preparations diagnosed as follicular lesions were examined by 4 different pathologists, a moderate to significant evaluation difference was detected among the pathologists (9). Seok et al found that, with examination of thyroid FNAB by thyroid speialistc cytopathologists, more accurate results could be obtained in a shorter time (10).…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic Characteristics of Thyroid Nodules in Predicting the Malignancy and the Role of the Cytopathologist

Kan

2021

Batı Karadeniz Tıp Dergisi

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Aim: It is very important to determine the correct nodules which should be evaluated with thyroid fineneedle aspiration biopsy (FNAB) and avoid unnecessary operations. In this study, we aimed to analyze the relationship and the compatibility between thyroid FNAB results with ultrasonographic features and the role of the pathologist who examines the specimens.Material and Methods: 458 patients with nodules who underwent FNAB were included in the study. The relationships between the ultrasonographic features (echogenicity, shape, margin, vascularization and calcification) and biopsy results and, the factor of the pathologist were evaluated retrospectively. Since there was no Bethesda VI (malignant) result, analyzes were made among 5 subgroups. FNAB procedures were considered as, inadequate or nondiagnostic, benign, atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS), follicular neoplasia and suspicion of malignancy.Results: Solid internal structure, irregular margin, hypoechogenicity, presence of microcalcification, nodules with taller than wide (AP> T) were found significantly different between the subgroups of Bethesda classification system (p<0.01, for all features). All suspicious features were found more common in the malignant suspicious nodules than the benign nodules. 63 of 211 preparations (29.8%), which were evaluated as Bethesda I and Bethesda III, were reported by a single pathologist, and statistically significant differences were found in comparison to the other pathologists (p<0.01). Conclusion:Ultrasonography features that include malignancy risk correlate with cytopathology results. The incidence of thyroid nodules is gradually increasing and therefore, it is important to perform biopsies according to ultrasonographic risk stratification. Moreover, working with a thyroid specialist pathologist may minimize the indeterminate results.

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“…Head and neck surgeons working at five other hospitals without a paper on CNB were contacted to obtain information on their use of CNB, and they confirmed that they rarely used CNB in clinical settings. Therefore, data from 14 papers [30,[32][33][34][35]41,46,[48][49][50]52,54,56,57] published by authors from eight hospitals favoring CNB were compared to data from 10 papers [25,28,29,37,38,43,45,47,53,60] published by authors from six hospitals that did not favor CNB to identify differences in the proportions of diagnoses according to the TBSRTC. Fig.…”

Section: Differences In the Proportions Of Diagnoses On Consecutive Fmentioning

confidence: 99%

Usage and Diagnostic Yield of Fine-Needle Aspiration Cytology and Core Needle Biopsy in Thyroid Nodules: A Systematic Review and Meta-Analysis of Literature Published by Korean Authors

Ahn

2021

Clin Exp Otorhinolaryngol

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Objectives. The usefulness of core needle biopsy (CNB) for the diagnosis of thyroid nodules remains controversial, and preferences vary across hospitals. The purpose of this study was to assess the actual use of CNB in Korea and to analyze the advantages and disadvantages of CNB through a systematic review and meta-analysis of papers published by Korean authors. Methods. A meta-analysis of full-text publications published in English presenting data from Korea retrieved from the Embase literature database was performed. Results. CNB led to a significantly lower proportion of non-diagnostic results than fine-needle aspiration (FNA). However, the frequency of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) did not decrease as a result of performing CNB in nodules with initial AUS/FLUS results, while it increased in consecutive cases. A subcategory analysis of AUS/FLUS showed that the increased frequency of AUS/FLUS findings on CNB was due to more frequent diagnoses of architectural atypia and follicular neoplasm, which resulted in a higher frequency of inconclusive findings in consecutive cases compared to FNA. Hospitals favoring CNB had a higher proportion of AUS/FLUS diagnoses. Although the complication rate did not differ significantly between CNB and FNA, serious complications of CNB did occur. Conclusion. A reduced frequency of non-diagnostic results may be a definite advantage of CNB over FNA. However, the increased frequency of diagnoses of architectural atypia and follicular neoplasm should be considered when selecting CNB as a diagnostic tool.

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Improvement of diagnostic performance of pathologists by reducing the number of pathologists responsible for thyroid fine needle aspiration cytology: An institutional experience

Abstract: Reducing the number of pathologists responsible for diagnostic thyroid FNA cytology resulted in a higher utilization rate of TBSRTC, and more rapid and accurate diagnosis.

Cited by 4 publications

References 19 publications

False positive cases in thyroid cytopathology – the experience of a single laboratory and a systematic review

False positive cases in thyroid cytopathology – the experience of a single laboratory and a systematic review

Ultrasonographic Characteristics of Thyroid Nodules in Predicting the Malignancy and the Role of the Cytopathologist

Usage and Diagnostic Yield of Fine-Needle Aspiration Cytology and Core Needle Biopsy in Thyroid Nodules: A Systematic Review and Meta-Analysis of Literature Published by Korean Authors

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