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

Abstract

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.

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

“…In comparison to our previously published results, AUS-HC screening diagnoses were more likely to be downgraded to benign (46.5%) compared to diagnoses of AUS-N or AUS-F [22,23]. Furthermore, AUS-HC screening diagnoses were less likely to be upgraded compared to AUS-F and AUS-N screening diagnoses.…”

“…For instance, data were based on retrospective review and thus diagnoses were rendered by a number of different CTs and cytopathologists. As we have shown and discussed in previous studies, the screening diagnoses made by different CTs are more likely to be in agreement and agreement appears to correlate with the experience of the CT [22,23]. While we did not examine agreement among individual cytopathologists, it is expected that some pairs of cytopathologists and CTs would have higher agreement rates than others.…”

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

“…This contrasts significantly with our findings that focused on nuclear atypia. In that work, there was strong agreement between CTs and cytopathologists regarding the diagnosis of PTC and an overall low two-category discrepancy rate for categories describing nuclear atypia (AUS-N, SPTC and PTC) [19]. …”

Assessment of cytotechnologist–cytopathologist interpretative agreement using the Bethesda system for reporting thyroid cytopathology

“…18 . For morphological correlation of follicular lesions, the following order was used: Benign (Cat.…”

“…16,17 Given the expanding role of CTs in providing ROSE and screening interpretations for thyroid FNA, it is also useful to evaluate the interobserver agreement between CTs' initial screening interpretations and the CPs' final interpretations. 18,19 Our institution adopted TBSRTC in March 2010, with each specimen being screened by a CT prior to CP assessment. 18,19 Our institution adopted TBSRTC in March 2010, with each specimen being screened by a CT prior to CP assessment.…”