US-guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: Adequacy of Cytologic Material and Procedure Time with and without Immediate Cytologic Analysis

Abstract

There was no significant difference in cytologic adequacy whether immediate cytologic analysis of aspirated material was performed or not. The procedure time was significantly shorter when immediate cytologic analysis was not performed.

The value of onsite adequacy assessment of thyroid fine-needle aspirations is a function of operator experience

“…Although studies have shown that onsite adequacy assessment dramatically reduces nondiagnostic aspirates and leads to significant cost savings, 4 some reports have questioned the added benefit of adequacy assessment in situations in which the FNA is performed under ultrasound (US) guidance. 5 Because onsite adequacy assessment may not be available in all situations, some authors have suggested that adequacy assessment not only has no effect in reducing nondiagnostic rates among USguided thyroid FNAs, but also unnecessarily increases the time required to perform the procedure. 5 To address this concern, we performed a study to confirm whether onsite adequacy assessment in fact results in a significant decrease in nondiagnostic rates among thyroid FNA cases, and whether US guidance obviates the need for the onsite adequacy assessment of aspirates.…”

“…5 Because onsite adequacy assessment may not be available in all situations, some authors have suggested that adequacy assessment not only has no effect in reducing nondiagnostic rates among USguided thyroid FNAs, but also unnecessarily increases the time required to perform the procedure. 5 To address this concern, we performed a study to confirm whether onsite adequacy assessment in fact results in a significant decrease in nondiagnostic rates among thyroid FNA cases, and whether US guidance obviates the need for the onsite adequacy assessment of aspirates.…”

“…4 Others counter that if the FNA is performed under US guidance, immediate cytologic evaluation only prolongs procedure time, increases patient discomfort, and wastes valuable cytologic and radiologic resources, without any significant increase in the number of diagnostic aspirates. 5 In 2002, Nasuti et al reviewed 5688 FNAs performed in various organs with onsite adequacy assessment. 4 They compared their very low (Ͻ 1%) nondiagnostic rate when the FNA was performed with onsite evaluation with the reported nondiagnostic rate of 20% for FNAs performed without immediate adequacy assessment.…”

“…5 The authors reviewed 50 retrospective and 21 prospective thyroid FNAs using onsite evaluation and compared them with 50 prospective FNAs that were performed without adequacy assessment. When they compared the 71 prospective cases in which the total procedure time had been recorded, they found that immediate adequacy assessment prolonged the average procedure time from 12.5 minutes to 44.4 minutes, without any significant decrease in the percentage of inadequate specimens among all 71 immediately evaluated specimens (24%) compared with 50 FNAs without adequacy assessment (20%).…”

Can We Improve Thyroid Fine-needle Aspiration Cytology Adequacy in a Low-volume Thyroid Center?

“…[20][21][22][23] In low volume thyroid centers, due to the small number of thyroid nodule FNACs, it is impractical to have instant cytological reporting of thyroid FNACs to assess for adequacy of follicular epithelial cell numbers, due to the low numbers of cases seen, though this has shown to be a useful adjunct to FNAC to minimize inadequacy rates in high-volume centers. 24 Concentrating the workload into the hands of dedicated, interested clinicians and pathologists may improve the outcome of FNAC. 25,26 Multiple authors are now in favor of surgeon-performed US-guided FNACs as this has proved to provide many advantages, especially in shortening the time to diagnosis and expediting management, 27,28 which is in line with our findings in this study.…”