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Laryngoscope. 2015 Jul;125(7):1633-6. doi: 10.1002/lary.25214. Epub 2015 Feb 20.

Surgeon-performed ultrasound-guided FNAC with on-site cytopathology improves adequacy and accuracy.

Author information

1
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
2
Department of Biological Sciences, University of Delaware, Newark, U.S.A.
3
Head and Neck Multidisciplinary Clinic, Helen F. Graham Cancer Center, Christiana Care, Newark, U.S.A.
4
Jefferson Integrated Bioscience Program, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
5
Doctors Pathology Services, Dover, Delaware, U.S.A.

Abstract

OBJECTIVE:

To demonstrate that surgeon-performed fine-needle aspiration cytology (FNAC) results in a high percent of satisfactory FNAC results; the number of passes to obtain a satisfactory cytological result with on-site cytopathological interpretation is reduced with ultrasound guidance (comparing FNAC with and without surgeon-performed ultrasound guidance); and immediate triage for indeterminate thyroid nodules can be performed in one setting for molecular testing, potentially improving selection for surgery.

STUDY DESIGN:

Retrospective cohort comparison.

METHODS:

A cytopathologist is present for on-site staining adequacy evaluation and molecular testing triage for indeterminate cytology. Overall cytological adequacy and number of passes required to obtain cytological adequacy for 200 consecutive patients are compared with a historical series of 100 consecutive patients from the same surgeon and cytopathologists without ultrasound guidance.

RESULTS:

The percent of patients with an adequate FNAC with ultrasound guidance was 100%. The mean number of passes with and without ultrasound guidance was 1.7 and 4.0 (P < 0.001). Indeterminate FNACs (9%) were triaged to molecular alteration testing and gene expression classifier testing.

CONCLUSIONS:

Surgeon-performed ultrasound-guided FNAC with an experienced cytopathologist present resulted in a cytologically adequate result in 100% of cases. Significantly fewer passes for a satisfactory result were achieved with ultrasound guidance. Indeterminate FNAC can be triaged for molecular testing in one patient visit, was required in only 9% of carefully selected patients, and improved patient selection for surgery. The percent of patients who went on to surgery was 24 of 200 (12%). The percent of patients who had malignancy was 18 of 24 (75%).

KEYWORDS:

Thyroid; fine-needle aspiration cytology; gene expression testing; molecular alteration testing

PMID:
25703413
DOI:
10.1002/lary.25214
[Indexed for MEDLINE]

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