Cytotechnologist-Attended On-Site Evaluation of Adequacy for Metastatic Disease Involving Bone and Soft Tissue

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Objective: To evaluate the performance of cytotechnologists in assessing the adequacy and accuracy of the preliminary diagnosis for fine-needle aspirates of the liver. Study Design: We retrospectively analyzed 10 years of data and found 589 cases of ultrasound-guided fine-needle aspiration (FNA) of the liver with on-site evaluation of adequacy (OSEA). All the OSEA were performed by the cytopathologist because OSEA of liver FNA is not performed by cytotechnologists at our institution at present. After OSEA, the material was seen by cytotechnologists who rendered an adequacy assessment and preliminary diagnosis. We calculated the adequacy and accuracy statistics and compared the performance of the cytotechnologists with the OSEA and final interpretation. Results: There was no statistically significant difference in adequacy downgrade rate for cytotechnologist versus cytopathologist assessment during the study period (5 vs. 3%, p = 0.06). A total agreement of 88% was noted in overall diagnosis with 97% agreement in malignant cases. Conclusion: Cytotechnologists assess the adequacy of liver FNA accurately and there is therefore potential for them to perform OSEA for liver FNA.

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accuracy of Cytotechnologist Evaluation of Specimen Adequacy and Screening Interpretation of Malignancy in Fine-Needle Aspiration of the Liver

Ahmed¹,

Novak²,

Sheerin³

et al. 2014

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“…the screening of nongynecological specimens, on-site evaluation of adequacy [1,2,3] and interfacing cytopathology with molecular methods [4]. Regulatory practices require quality performance measures for evaluating an individual's skill at interpreting Pap tests [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Cytotechnologist Performance for Detecting Nuclear Atypia in Indeterminate Thyroid Fine Needle Aspirates

VandenBussche

Adams

Ali³

et al. 2014

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Introduction: The thyroid gland is arguably the fastest growing anatomic site for fine needle aspiration (FNA). With the increase of thyroid cases, a reevaluation of cytotechnologist screening quality metrics in terms of thyroid FNA is called for. We present our institutional cytotechnologist performance at screening for nuclear atypia by applying established quality metrics. Materials and Methods: Information on 8,814 consecutive thyroid cytopathology cases over a 10-year period was retrieved from computerized records. A subsample of cases categorized either as atypia of uncertain significance with nuclear atypia or suspicious for malignancy with features suspicious for papillary thyroid carcinoma. The cytotechnologist and cytopathologist diagnoses were compared using step discrepancies and Δ-ratios. Results: Overall discrepancy between the cytotechnologist and cytopathologist diagnoses existed in <10% of all thyroid cases. One-category discrepancies were the most common (7.8%), while two-category discrepancies were rare (0.5%). The one-category discrepancy rate correlated with cytotechnologist experience. One-category undercalls were twice as common as overcalls (5.3 vs. 2.5%, p < 0.0001). Conclusions: We identified a high level of quality in the screening for nuclear atypia in thyroid FNA. The one-category discrepancy rate is suited to tracking individual cytotechnologist performance, identifies outliers and appears to correlate with cytotechnologist experience.

“…For instance, CTs have demonstrated usefulness in the performance of on-site evaluation of adequacy (OSEA; also known as Rapid On-site Evaluation or ROSE) [1,2,3,4], the screening of nongynecological specimens [5] and interfacing cytopathology with molecular methods [6]. Concurrently, thyroid fine-needle aspirations (FNA) have more than septupled at our institution over the past decade [3] and are becoming the most common nongynecological specimens in most cytopathology laboratories.…”

Section: Introductionmentioning

confidence: 99%

Cytotechnologist Performance for Screening Microfollicular Atypia in Indeterminate Thyroid Fine-Needle Aspirates

VandenBussche¹,

Olson²,

Adams³

et al. 2014

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Introduction: We previously identified a high level of accuracy among our cytotechnologists (CTs) for identifying nuclear atypia in thyroid fine-needle aspiration (FNA) specimens. Herewith, we present our CT performance at screening for microfollicular atypia. Methods: 8,814 thyroid FNA specimens were identified in our archives, all screened by 1 of 11 CTs and signed out by a cytopathologist. A subsample of cases was categorized either as atypia of uncertain significance (AUS) with microfollicular proliferation (AUS-F) or suspicious for a follicular neoplasm (SFN). Results: The agreement rate was low between CTs and cytopathologists for SFN and AUS-F. Only 55.8% of SFN screening diagnoses were upheld; 27.9% were downgraded to AUS, 10.4% were downgraded to benign, and 5% were upgraded. Of AUS-F screening diagnoses, 35.5% were upheld, 33.7% were downgraded to benign, and 20.2% were upgraded to SFN. Among all cases, two-step discrepancies were uncommon. Conclusion: Most disagreements were one-category discrepancies between AUS-F and SFN. The evaluation of microfollicular atypia is challenging given that certain follicular lesions cannot be definitively diagnosed on cytology, a high level of subjectivity is involved in the interpretation of such lesions, and the presence of nuclear or Hurthle cell atypia may complicate the diagnosis.