[422] Utility of the Rotex Needle for Thyroid Fine Needle Aspiration (FNA)

ET Jones, JA Maksem, JG Andriole. Orlando Health, Orlando, FL

Background: Ultrasound-guided FNA is commonly used for the assessment of thyroid nodules. While most FNAs use a conventional hollow needle, we report our experience using the Rotex needle, which employs an inner screw-shaped stylet within an outer cannula. The Rotex needle has been used for the percutaneous FNA of lung, liver, kidney, lymph node, and other sites. Its use in the assessment of thyroid nodules has not been published. The majority of thyroid FNAs at our institution are performed by interventional radiologists using the Rotex needle without intraoperative adequacy assessment.
Design: Thyroid FNA results from 1/1/2009 to 9/30/2009 were retrospectively analyzed. Data collected included location of procedure, type of biopsy device used (Rotex or hollow needle), number of sites biopsied, diagnosis, and histologic diagnosis for cases that had concurrent core biopsy or subsequent resection. FNA diagnoses were categorized as nondiagnostic, benign (nodular goiter, hyperplastic nodule, adenomatoid nodule, thyroiditis), (suspicious for, cannot exclude, indeterminate for, consistent with, favor) follicular neoplasm, (suspicious for, consistent with) papillary carcinoma, and other carcinoma.
Results: FNA diagnoses from 285 thyroid sites among 228 patients were available, 176 using Rotex needles and 109 with hollow needles. Results are shown in Table 1.

Table 1: Thyroid FNA Results

Cytologic Diagnosis	Rotex	Conventional
Nondiagnostic	13 (7.4%)	12 (11.0%)
Benign	105 (59.7%)	76 (69.7%)
Follicular Neoplasm	50 (28.4%)	16 (14.7%)
Papillary Carcinoma	7 (4.0%)	5 (4.6%)
Other Carcinoma	1 (0.6%)	0

Histologic diagnoses were available for 48 sites after Rotex FNA and are shown in Table 2.

Table 2: Rotex Cytologic and Histologic Diagnoses

	Histologic Diagnosis
Cytologic Diagnosis	Benign	Follicular Adenoma	Papillary Carcinoma
Nondiagnostic	1	0	0
Benign	12	7	1a
Follicular Neoplasm	9	10	1b
Papillary Carcinoma	0	1	6

^a0.9 cm papillary carcinoma next to larger benign nodule ^b4cm adenoma containing 0.5cm papillary carcinoma


Conclusions: Thyroid FNA with the Rotex needle (93% adequacy) compared favorably to conventional needle FNA (89% adequacy), with a higher rate of follicular neoplasm diagnosis (28% vs 15%), possibly due to the larger tissue fragments obtained with the Rotex needle. Additionally, the Rotex needle offers the advantages of ease of use, high echogeneity, a more concentrated sample requiring fewer slides, and no need for an aspiration device.
Category: Cytopathology

Tuesday, March 23, 2010 1:45 PM

Platform Session: Section D, Tuesday Afternoon