Rates of Thy 1‐non‐diagnostic thyroid fine needle aspiration using the UK Royal College of Pathologists Thy Terminology. A systematic review of the literature comparing patients who undergo rapid on‐site evaluation and those who do not

Abstract

Introduction: The UK Royal College of Pathologists (RCPath) Thy terminology is an internationally recognised system for reporting thyroid fine needle aspiration. The terminology has been used throughout the UK and Ireland, in some parts of Italy and Switzerland, and elsewhere in the world. There is no systematic review of the literature specifically addressing the use of the non-diagnostic for cytological diagnosis-Thy1/Thy 1c category in the UK RCPath terminology. Methods: A comprehensive literature search of online databases was conducted in October 2019 specifically examining overall reported rates of Thy1 and Thy1c in aspirates classified according to the UK Thy terminology. Results: Twenty-five articles were identified showing a Thy1 rate of 13.4% (2540/18 920). The studies were then stratified according to whether or not the patients underwent rapid on-site evaluation (ROSE): 6.0% (353/5841; range 3.0%-10.9%) of ROSE aspirates were Thy1 whereas 18.5% (2072/11 204; range 7.9%-43.3%) of non-ROSE patients were Thy1; (P < .05). Three studies from 2016 reported Thy1c rates of 5.4%, 6.5% and 10.6%, respectively, implying Thy1 rates excluding Thy1c aspirates of 20.9%, 8.7% and 12.7%, respectively. Conclusion: This systematic review of the literature shows relatively high rates of aspirates non-diagnostic for cytological diagnosis-Thy1 in the peer-reviewed published literature using the UK terminology. Utilisation of ROSE appears to produce lower rates of Thy1 aspirates and ROSE should be considered if rates of non-diagnostic for cytological diagnosis-Thy1/Thy 1c are high.

Role of Pathologist in the Era of Image-Guided and EUS-Guided Aspirations: A 10-Year Study at a Single Tertiary Care Oncology Institute in North India

“…The inadequacy of aspirates has been reported in numerous studies varying from 0.1% to 29%, for various sites and methods [3, 5, 14-24]. Our overall inadequacy rate varied from 3.4% to 9% which is comparable with other large studies.…”

“…Bellivicine et al [15] also reported similar findings in their study. This is further corroborated in a systemic review of literature on Thy1 (non-diagnostic thyroid aspirate) category published by Poller et al [14] in 2020, the inadequacy rates were 13.4% overall, and on stratification with ROSE and without ROSE showed 6% and 18.5% inadequacy, respectively.…”

Comparison of British Thyroid Association, American College of Radiology TIRADS and Artificial Intelligence TIRADS with histological correlation: diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate

“…A systematic review published earlier this year 14 regarding sites using the UK Royal College of Pathology reporting system found a non-diagnostic, i.e . Thy1, cytology rate ranging from 3.0 to 43.3%.…”

What is Thy3a? A study of 336 Thy3a (AUS/FLUS) thyroid FNAs with histology compares UK RCPath with other reporting systems and shows how Thy3a subclassification can improve risk stratification and help address overuse of this category

“…Although this suggests a need to review regional aspiration practice, a recent review of literature using the RCPath terminology reported Thy1 rates to range from 7.9%‐43.3% 25 . ROSE appears to lower Thy1 rates 25,26 . While the introduction of ROSE would therefore be desirable in our setting, implementation has not been practical due to the number of sites that we serve, with other mitigating factors including lack of space in radiology departments and time constraints with ultrasound lists.…”

“…Our Thy1 rate is also high (25%). Although this suggests a need to review regional aspiration practice, a recent review of literature using the RCPath terminology reported Thy1 rates to range from 7.9%‐43.3% 25 . ROSE appears to lower Thy1 rates 25,26 .…”