Comparison of Cytopathologist-Performed Ultrasound-Guided Fine-Needle Aspiration With Cytopathologist-Performed Palpation-Guided Fine-Needle Aspiration: A Single Institutional Experience

Abstract

Context.-Although fine-needle aspiration (FNA) practice by pathologists is now well established, it has been primarily performed by manual palpation. In recent years, pathologists have begun to venture into ultrasound-guided FNAs (UGFNAs). Reports on experiences with this relatively new technique for pathologists have shown promising results. However to date, there have been few studies in the literature comparing pathologist-performed UGFNA with the more traditional pathologist-performed palpation-guided FNA (PGFNA).Objective.-To compare UGFNA to PGFNA by cytopathologists at an academic medical center.Design.-A retrospective study of FNAs performed by cytopathologists within the University of California, Los Angeles (UCLA) pathology departmental FNA clinic was performed. Data collected included performance technique (UGFNA versus PGFNA), lesion site and size, adequacy status (nondiagnostic rate), and number of passes per procedure. Corresponding surgical pathology/ flow cytometric/cytogenetic result follow-up was compared to FNA results. Findings between UGFNA and PGFNA cases were compared.Results.-Of 1029 FNA cases during the study period, there were 449 UGFNA cases (43.6%) and 580 PGFNA cases (56.4%). Nondiagnostic rates with UGFNA and PGFNA were 6.7% (30 of 449 cases) and 20.7% (120 of 580 cases), respectively. Nondiagnostic rate was also significantly lower with UGFNA than with PGFNA for lesions within the thyroid (6.0% versus 33.3%), head and neck (6.6% versus 21.2%), and salivary gland (6.2% versus 17.1%), and across all nodule sizes. A total of 495 of 1029 FNA cases (48.1%) had follow-up. Discordance rate was significantly lower with UGFNA than with PGFNA (5.4% versus 12.8%).Conclusions.-This study shows improved performance characteristics of cytopathologist-performed UGFNA versus PGFNA.

The Milan System for Reporting Salivary Gland Cytopathology—Proposed modifications to improve clinical utility

“…The challenges in accurately identifying salivary gland lesions and distinguishing these from their morphologic mimics based on cytology alone are well known . The positive predictive value of salivary gland cytology is often related to the technique of acquisition, quality of the smears, the experience of the cytopathologist as well as the availability of material for ancillary tests such as immunohistochemistry and flow cytometry …”

Diagnostic Accuracy of Fine‐Needle Biopsy for Salivary Gland Neoplasms in a Community Otolaryngology Practice

“… 9 Additionally, US guidance has been shown to improve the diagnostic rate of FNBs: a 2018 retrospective study of FNBs performed by cytopathologists at an academic medical center demonstrated a statistically significant reduction in nondiagnostic samples with US guidance, from 21.2% to 6.6% ( P < .001). 7 US guidance may help to target nonpalpable lesions, as well as solid versus cystic or necrotic regions, and avoid nearby vessels, thereby increasing the diagnostic rate and decreasing the complication risk. 7 , 8 This result was replicated in our study, which demonstrated that US FNB was statistically more likely to yield a diagnostic specimen ( P = .00002).…”

“…3,[6][7][8] Cytopathologists may be on-site to determine specimen adequacy at the time of biopsy, and the resulting specimens are generally examined at a single tertiary care institution. 3,[6][7][8] Indeed, some studies examining the utility of FNB for salivary gland lesions note that variations in technique, operator, and pathologists (community vs academic practice) may be confounding factors in establishing its usefulness. 5 The majority of patients with salivary gland lesions first present to community otolaryngology practices.…”

“… 3 , 6 - 8 Ultrasound-guided FNB is commonly performed by radiologists or pathologists rather than otolaryngologists. 3 , 6 - 8 Cytopathologists may be on-site to determine specimen adequacy at the time of biopsy, and the resulting specimens are generally examined at a single tertiary care institution. 3 , 6 - 8 Indeed, some studies examining the utility of FNB for salivary gland lesions note that variations in technique, operator, and pathologists (community vs academic practice) may be confounding factors in establishing its usefulness.…”

Fine-Needle Aspiration-Based Patient-Derived Cancer Organoids

“…For palpable lesions, the sample can be obtained from patients at the bedside with minimal discomfort and limited, if any, use of local anesthetic. For deeper lesions, the technique can be combined with ultrasound ( Conrad et al., 2018 ) or performed under computed tomography (CT) guidance to precisely target the lesion of interest. FNA can also be performed directly on resected or biopsied tumor tissues immediately after surgery.…”