Effects of Rapid On-Site Evaluation on Diagnostic Accuracy of Thyroid Fine-Needle Aspiration

Abstract

<b><i>Introduction:</i></b> Fine-needle aspiration (FNA) is well-established for the evaluation of suspicious thyroid nodules. However, a significant proportion is nondiagnostic. Rapid on-site evaluation (ROSE) has been proposed to improve the overall adequacy of FNA. <b><i>Methods:</i></b> Retrospective cohort study comparing adequacy of thyroid FNA findings pre- and postimplementation of ROSE at a tertiary center in Switzerland. Patients undergoing thyroid FNA from January 2016 to December 2019 were included. The primary outcome was the rate of nondiagnostic findings (Bethesda System for Reporting Thyroid Cytopathology category I). <b><i>Results:</i></b> In total, 410 thyroid nodule FNAs were performed. Of those, 309 with standard FNA and 101 with ROSE. The majority of patients were female (71%), with a median age of 56 years (IQR 46–68) and a nodule diameter of 1.9 cm (IQR 1.2–2.9). Implementation of ROSE led to a decrease in nondiagnostic findings from 41.1% to 23.8%, with an odds ratio of 0.42 (95% CI: 0.24–0.72; <i>p</i> = 0.002). Implementation of ROSE was associated with significantly higher rates of Bethesda category III (27.7% vs. 19.1%), category IV (15.8% vs. 5.5%), and Bethesda category VI (6.9% vs. 2.3%). Repeated FNA was performed in 29.1% before and 20.8% after implementation of ROSE (<i>p</i> = 0.18). The mean number of FNA per nodule was reduced from 1.4 (0.6) to 1.2 (0.4) with ROSE (<i>p</i> = 0.04). <b><i>Conclusions:</i></b> Implementation of ROSE of thyroid nodule specimen improved diagnostic adequacy of FNA, reducing nondiagnostic findings. However, due to increased equivocal findings (Bethesda category III), there was no significant reduction of repeat FNA.

Validation of a Cytological Classification System for the Rapid On-Site Evaluation (Rose) of Pulmonary and Mediastinal Needle Aspirates

“…The authors concluded that ROSE with a Bethesda categorization significantly increased diagnostic accuracy at both qualitative and quantitative levels, resulting a standard of care for thyroid FNA. Similarly, in a study by Fawcett et al [ 23 ] of 309 FNAs and 101 cases with ROSE, implementation of ROSE decreased the nondiagnostic cases from 41.1% to 23.8%. Procedures performed with ROSE also decreased repeated FNAs from 29.1% to 20.8%, even reducing the number of FNAs per nodule from 1.4 to 1.2 ( p = 0.04).…”

“…ROSE is a widely used and effective diagnostic procedure during a needle aspiration biopsy of different organs [ 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. In the field of thoracic pathologies, several studies have demonstrated the utility of ROSE during both transbronchial and percutaneous needle aspiration techniques [ 1 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

Combined fine needle aspiration cytology and core needle biopsy in the same setting: A two‐years’ experience

“…Fine needle aspiration cytology (FNAC) is a rapid, safe, minimally invasive and highly accurate diagnostic tool for evaluating benign and malignant conditions 1–8 in various superficial and deep‐seated organs, including lymph nodes 9–12 . The incorporation of rapid on‐site evaluation (ROSE) further enhances its utility by gauging sample adequacy, leading to a notable decrease of approximately 20% in inadequate rates 4,13 . The precision of FNAC's diagnostic outcomes is augmented through immunocytochemistry (ICC) on diverse substrates such as cell block (CB), liquid‐based cytology (LBC) or smears, along with molecular testing, 14–17 and flow cytometry (FC) for lymphoproliferative processes 6,10,18–24 …”

“…Nonetheless, despite the documented high sensitivity and specificity values, 2,4,25 FNAC may prove insufficient to reach actionable diagnoses in certain pathologies, particularly those necessitating extensive immunohistochemical panels and molecular testing, or intricate cases wherein histological architectural features are pivotal for diagnosis 5,20 . Core needle biopsy (CNB) emerges as a potent sampling technique offering the advantage of revealing tissue architecture and obtaining samples more substantial than those garnered via FNAC and CB.…”

“…Fine needle aspiration cytology (FNAC) is a rapid, safe, minimally invasive and highly accurate diagnostic tool for evaluating benign and malignant conditions [1][2][3][4][5][6][7][8] in various superficial and deep-seated organs, including lymph nodes. [9][10][11][12] The incorporation of rapid onsite evaluation (ROSE) further enhances its utility by gauging sample adequacy, leading to a notable decrease of approximately 20% in inadequate rates.…”