Ultrasound-guided fine-needle aspiration biopsy of the thyroid: Role of on-site assessment and multiple cytologic preparations

Abstract

Several studies have shown that ultrasound guidance can serve as a valuable aid in improving the diagnostic yield of fine‐needle aspiration (FNA) biopsy of thyroid nodules. In this study, we evaluated the combined impact of ultrasound‐guidance, rapid on‐site evaluation of FNA specimens, and different cytologic preparations (fresh and alcohol‐fixed smears, Millipore filter) and staining methods (Diff‐Quik and Papanicolaou stains) on the diagnostic yield of thyroid FNA. Ultrasound‐guided FNA was performed on 282 patients (313 cases) between November 1997 and April 1999. The diagnostic categories included: benign (198 cases, 63.2%); indeterminate (42 cases, 13.4%); suspicious for follicular variant of papillary carcinoma (26 cases, 8.3%), malignant (32 cases, 10.1%); and nondiagnostic (15 cases, 5%). The nondiagnostic cases also included 6 cystic lesions without any solid component and 3 thyroid‐bed aspirations. After excluding these, the nondiagnostic rate was only 2%. Histological follow‐up was available in 77 (77/313) cases. The concordance rate between cytological and histological diagnosis was 100% in malignant, 67% in suspicious, and 56% in indeterminate cases. All cases with histologic follow‐up were selected to evaluate the independent diagnostic efficacy of each aforementioned cytologic staining method. A definite diagnosis could be made solely on the basis of air‐dried, Diff‐Quik‐stained preparations in 50 (65%), alcohol‐fixed, Papanicolaou stained smears in 68 (88%), and Millipore filter preparations in 70 (91%) cases. We conclude that ultrasound‐guided FNA combined with on‐site evaluation and different cytologic preparations can significantly improve the diagnostic accuracy of thyroid FNA specimens. Diagn. Cytopathol. 2000;23:425–429. © 2000 Wiley‐Liss, Inc.

Thin core needle biopsy crush preparations in conjunction with fine-needle aspiration for the evaluation of thyroid nodules

“…Although the unsatisfactory rate for thyroid biopsies reported in the literature is variable, there is general agreement that onsite evaluation results in higher adequacy rates, and some evidence suggests that the use of ultrasound guidance improves adequacy. 16,[24][25][26] Unsatisfactory rates in the range of 4% to 5% have been reported for freehand and ultrasound-guided FNA with onsite evaluation, whereas rates from 10% to 43% have been reported for centers without onsite evaluation. 25,27 We have observed that the performance of CB in conjunction with FNA is very useful in further improving adequacy rates, especially when CP are assessed on site for adequacy.…”

Fine-needle aspiration of thyroid nodules: A study of 4703 patients with histologic and clinical correlations

“…In addition, it has been proven that on-site adequacy evaluation can reduce inadequate samples significantly. 19,20 The issue regarding the number of follicular cells required for adequacy has been debated over the years; and, to date, no consensus has been reached. 2 Until a standardized, practical guideline is established, each individual cytopathologist will have to use criteria with which he or she is comfortable.…”

“…Thorough physical examination, multiple passes to cover all areas of interest, and ultrasound-guided aspiration may reduce sampling errors. 19,21 Errors caused by misinterpretation of cytologic findings in adequate samples are uncommon. Two major sources of such errors are cystic PCT and FN.…”

Hepatic fine-needle aspiration cytology: The role of rapid on-site evaluation in the assessment of hepatic lesions

“…The role of ROSE has been explored in the endoscopic-guided FNAC of thyroid lesions, pancreatic masses, TBNA of mediastinal and lymph nodal masses, and lung cytology, while we have studied the impact of ROSE on yield of ultrasound-guided FNACs of hepatic lesions (2,8,9,11,(13)(14)(15).…”