Interinstitutional consultation in fine‐needle aspiration cytopathology

Abstract

BACKGROUND: The importance of interinstitutional consultation (IC) has been documented across a variety of surgical pathology organ systems. However, to the authors' knowledge, few studies exist regarding this practice within cytopathology and specifically within fine‐needle aspiration cytology (FNAC). METHODS: All FNAC cases between September 2002 and January 2007 were reviewed. Original diagnoses and second opinion diagnoses (SODs) were categorized as either no diagnostic disagreement, or minor diagnostic disagreement, or major diagnostic disagreement, and the latter was defined as either a 2‐step deviation on a scale of “unsatisfactory, benign, atypical, suspicious, and malignant” or a change in treatment and/or prognosis. Outcome was determined by a review of the electronic medical record. RESULTS: Among 742 FNAC cases from outside laboratories, there were minor disagreements in 132 cases (17.8%) and major disagreements in 69 cases (9.3%) compared with the SODs from the authors' laboratory. Follow‐up was available for 60 of 69 major discrepancies. The SOD was supported on follow‐up in 65% of major discrepancies, and the initial diagnosis was supported better in 33% of major discrepancies. In 55% of cases in which the original institution diagnosis was supported better, either no case slides were received for examination or the slides contained material that was considered nondiagnostic by the authors. An SOD prompted a change in clinical management in 32 of 742 patients (4.3%). Aspirates that were most prone to change in management or therapy were from the thyroid (13 cases), neck (soft tissue and lymph nodes; 9 cases), salivary gland (2 cases), and liver (2 cases). Of 60 major diagnostic disagreements, board‐certified cytopathologists rendered an SOD in 44 cases, and 75% of the diagnoses were supported better by follow‐up, whereas pathologists who were not board certified in cytopathology had only 38% of SODs supported. CONCLUSIONS: Of 742 FNAC cases, 9.3% had major diagnostic disagreements; and, in 4.3%, patient management and therapy were altered. These results were similar to studies in surgical pathology emphasizing the importance of IC in FNAC. The authors concluded that FNAC IC benefits patient care. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.

The UK Royal College of Pathologists Thyroid Fine-Needle Aspiration Diagnostic Classification Is a Robust Tool for the Clinical Management of Abnormal Thyroid Nodules

“…The likelihood of malignancy for each cytological reporting category should be known locally [9,31,32]. Recently published data regarding thyroid cancer detection for thyroid FNA [33] indicate a sensitivity for diagnosis of malignancy of between 65 and 98% and a specificity of 76–100%, with a false-negative rate of 0–5%, a FP rate of 0–5.7%, and an overall accuracy of 69–97% [34,35]. …”

Evaluation of Indeterminate Thyroid Cytology by Second-Opinion Diagnosis or Repeat Fine-Needle Aspiration: Which Is the Best Approach?

“…In contrast, studies that were published before the introduction of the BRSTC nomenclature included a range of different terms for the indeterminate diagnostic category, such as ‘ruling out follicular neoplasm or lesion' [14], ‘follicular lesion' [11,15], ‘cannot exclude follicular neoplasm' [10], ‘atypical cells' [11], ‘indeterminate' [16,17], ‘indeterminate for neoplasm' [20,23,25] and ‘inconclusive/indeterminate' [22]. …”

“…We chose studies regarding the terms ‘repeat thyroid FNA' and ‘atypia of undetermined significance' and studies containing information about interinstitutional consultation or second opinion coupled with the terms ‘cytology' or ‘thyroid cytology'. Twenty-three publications were selected: 9 evaluated the role of SOD in the field of thyroid FNAs [10,11,12,14,15,16,17,18,19] and 14 examined the issue of RFNA [20,21,22,23,24,25,26,27,28,29,30,31,32,33]. …”

“…Jing et al [5], for instance, reported that intradepartmental consensus review of 50 thyroid aspirates previously classified as AUS/FLUS resulted in a definitive diagnosis in 74% of the cases with a consequent improvement of diagnostic accuracy. Indeed, examination of pathological material, including cytological specimens, is an accepted practice in many institutions, especially in the context of a second opinion for referred patients before clinical management [6,7,8,9,10,11]. In a large series of institutional consultations for 3,885 thyroid FNAs, Olson et al [12] showed that the second review significantly decreased the rate of indeterminate cytological diagnosis with an increase in numbers of nondiagnostic (unsatisfactory), benign and malignant diagnoses.…”

Impact of a Single-Day Multidisciplinary Clinic on the Management of Patients with Liver Tumours

“…Most commonly, the pathology diagnosis was changed because of a reinterpretation of the immunohistochemistry staining done at the outside institution. In a previous study, Bomeisl et al 29 reported that a change in management was suggested for 2.6% of patients (n = 2) based on the results of a pathology second opinion, and that a major disagreement in the pathology findings arose for 9% (n = 7). In another study, Layfield et al 30 reported a 16% overall rate of diagnosis disagreement in second-opinion reviews of outside cytology specimens, with the greatest number of cases coming from lung, thyroid, and liver.…”