Is There a Role for On-Site Evaluation of Thyroid Fine Needle Aspiration to Reduce the Nondiagnostic Rate?

Abstract

The use of immediate on-site evaluation of fine-needle aspiration biopsy (FNAB) specimens can determine the adequacy of specimens and provides a specific preliminary diagnosis. In this prospective study, we evaluated the impact of on-site assessment of thyroid FNAB performed under ultrasound guidance. Totally, 204 (170 female, 34 male) patients (102 on site, 102 control group) were included. The patients were randomized on site and regular cytologic examination groups. Quick May-Grünwald Giemsa stain was used for on-site examination and FNA was continued until adequate aspirate for optimal cytological examination. Two (2.0 %) of the 102 patients evaluated with on-site examination had a nondiagnostic result. However, 16 (15.7 %) of the 102 patients examined by regular cytologic examination method, had nondiagnostic result. The difference between these two groups was statistically significant (p < 0.0001). The major cause of a nondiagnostic thyroid FNAB specimen is the failure to aspirate a sufficient number of cells necessary for diagnosis cystic lesions. Immediate on-site evaluation can significantly decrease the nondiagnostic rate of thyroid FNAB specimens.

The impact of rapid on‐site evaluation on thyroid fine‐needle aspiration biopsy: A 2‐year cancer center institutional experience

“…Therefore, efforts should be made to optimize specimen handling and adequacy. In the current study, the implementation of ROSE significantly increased the percentage of nodules deemed adequate for analysis in the final cytology report, with a final ND rate of only 6.6% in the ROSE group, a finding that is comparable to several experiences reported in the literature . Unfortunately, no review of ND cases among the ROSE group was performed, and a clear cause of unsatisfactory results could not be determined from the collected data.…”

“…However, the impact of ROSE on thyroid FNAB has been a matter of debate. Although some authors have reported a significant increase in specimen adequacy and a decrease in the mean number of needle passes required with ROSE, others have advocated that its benefits are limited, with extended procedure times and higher costs . In the current study, we retrospectively reviewed all thyroid FNABs performed in our service within the last 2 years to assess the impact of the incorporation of ROSE on the overall management, adequacy rate, and final diagnosis of the specimens.…”

Guidelines for the management of thyroid cancer

“…Immediate assessment of the sample for adequacy by biomedical scientists or pathologists at the time of aspiration can reduce the rate of unsatisfactory samples and be cost‐effective especially if the underlying adequacy rate is low , and facilitate collection of material for ancillary tests.…”

Evaluation of a dedicated ultrasound fine needle aspiration service for thyroid nodules

“…The overall ND rate in the post‐thyroid service group was relatively high compared with the literature (2–24%) . In 2016, our thyroid service had a clear reduction in ND rates, from 13.9% in 2015 to 6.1%.…”

“…Factors that influence sample adequacy include nodule characteristics (size, cystic versus solid, cellularity, vascularity and fibrosis), experience level of operators and cytopathologists, procedural variations (slide preparation, fixation and staining techniques; number of needle passes, size of needle gauge and aspiration versus non‐aspiration sampling techniques), and the presence of on‐site cytology assessment for sample adequacy . Studies have shown that on‐site cytology can reduce the ND rates of US‐guided FNAs …”