Thyroid Ultrasound Guided Fine Needle Aspiration Biopsies (US-FNA) Performed by Cytopathologists. The Lexington KY. Veterans Administration Hospital Experience
S Kavuri, MG Disanto, YM Brill, R Hall, B Holland, P Green, LM Samayoa. University of Kentucky, Lexington, KY; Universta' degli Studi di Siena, Siena, Italy; Veterans Administration Medical Center, Lexington, KY
Background: Recently, the demand for thyroid US-FNA for both palpable and non-palpable masses has increased; this may limit cytopathologists from performing aspirations of this anatomic site. Our study shows that with adequate training a cytopathologist can efficiently and safely utilize ultrasound (US) as a localizing devise for thyroid aspirations.
Design: Cytologic smears of 100 consecutive patients that underwent thyroid US-FNA by a cytopathologist, were reviewed for adequacy, duration of procedure, number (#) of passes, # of slides, percentage (%) of surface area smeared per slide(p/s), # of follicular cell groups p/s, % of obscuring blood, diagnosis (dx), histologic correlation and immediate and remote complications. All patients had thyroid lesions 1cm diagnosed and documented by a radiologist with 9 to 21 months of follow up. Alcohol prep pads (70%) were used to cleanse the skin without sterile draping. Soap and water solution instead of US gel was utilized. The biopsy was performed using 27 G x 1 1/2 needles with no aspiration and without local anesthesia. Pressure with sterile gauge was applied after each pass. Biopsy material was smeared using the Karolinska methodology and subsequently stained [Papanicolaou and Diff-Quik (DQ)]. Immediate evaluation to determine adequacy was performed after each pass using DQ stain.
Results: All patients had adequate material. On average, the duration of the procedure was 30 minutes, and each patient had 3 passes and 8 slides with a surface area of 40-50% p/s. Between 6 and 30 groups of follicular cells p/s were seen in 90 patients. Six patients had an average of 2 cell groups and 4 patients had an average of 5 cell groups p/s. Obscuring blood was seen in < 10 patients. Ninety six patients had a diagnosis consistent with colloid nodule/goiter and/or a component of lymphocytic thyroiditis. Two patients had histologically confirmed papillary carcinoma and another 2 patients had follicular lesions that proved to be minimally invasive follicular carcinoma and follicular adenoma. No acute or late complications were reported.
Conclusions: Using the described methodology, US-FNAB of thyroid lesions can be performed by a cytopathologist without complications and can be cost effective, efficient and diagnostically accurate.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 38, Wednesday Afternoon