Private practice outpatient fine needle aspiration clinic: A 2018 update

Abstract

This review updates a 2008 report on the establishment of a pathologist‐directed ultrasound‐guided fine needle aspiration (USGFNA) biopsy clinic in a private practice setting. During this time, ultrasound evaluation of the thyroid has evolved from simply sampling a nodule to a reliable cancer risk assessment (CRA). Because of perceived poor reliability in many local radiology thyroid ultrasound reports, first endocrinologists and then pathologists began performing their own ultrasound evaluations, cancer risk assessments, and USGFNAs. The present review covers a wide range of topics, including incorporating ultrasound data into a report, the uniqueness of the thyroid as an USGFNA target, artifact pseudocomplexity mimicking neoplasia, the pathologist’s ability to acquire thyroid cancer risk assessment expertise, and distinguishing a true thyroid nodule from a pseudonodule with appropriate documentation. The use of ultrasound does not change the core need for high‐level biopsy and smear‐making techniques. Two national courses offer advanced training and certification. Selection of mission‐appropriate ultrasound machines is discussed along with the pitfalls of purchase. Determining the location of a USGFNA clinic requires several considerations, as does the layout detail of the clinic interior for optimal patient comfort and experience. Ultrasound does not obviate the pathologist’s anticipation of patient concerns or of providing information, including revealing a cancer diagnosis. The goal of this review is to help guide the reader to successfully and beneficially bring the science of USGFNA to patients in an understandable and caring way.

Teaching FNA techniques and ultrasound guided FNA

“…The intranodular dwell time begins when the needle enters the target lesion. This paradigm helps to optimize the cellular yield and decrease blood dilution . Ljung discusses and illustrates beautifully the concept of sample procurement in a video that is available on YouTube…”

Thyroid FNA: Is cytopathologist review of ultrasound features useful?

“…There is variation even among experienced clinicians about how these criteria are interpreted and applied. Some have written that cytopathologist review of thyroid US is extremely useful and can be helpful in triaging patients [19][20][21][22] . This editorial looks more closely at the implications of this for practicing cytologists in three different circumstances: participating in the management of thyroid nodules after FNA, deciding which nodules should be submitted to FNA and how to perform an aspiration biopsy, and evaluating the cytological diagnosis with respect to the US pattern.…”