Thyroid FNAs and Clinical Outcomes: An Institutional Quality Assurance Project
Jamie L Odem, Magda Esebua. University of Missouri, Columbia, MO
Background: Since The National Cancer Institute's summation for thyroid fine needle aspirations (FNAs) in 2008, multiple studies have confirmed the Bethesda System's utility in standardizing terminology and predicting malignancy rates for thyroid FNAs. The goals of our review were to determine: 1. our adherence to the Bethesda terminology; 2. our malignancy rates in comparison to the literature; 3. how we can improve patient care through multidisciplinary education; and 4. how ancillary molecular testing may improve patient care.
Design: Our study reviewed every thyroid fine needle aspirate performed in 2010, totaling 243 FNAs from 178 patients. For each patient, any previous and subsequent (until May 2011) FNAs were also reviewed. Each FNA was classified and data gathered as to clinical follow-up, including ancillary molecular studies.
Results: Of 243 FNA's, 17% were unsatisfactory (Unsat), 39% benign (Ben), 25% atypical/follicular lesion of undetermined significance (AFLUS), 12% suspicious for follicular neoplasm (SFN), 3% suspicious for malignancy (SM), and 5% malignant (Mal). 13% of FNA diagnoses did not adhere to the Bethesda terminology and were placed into the most appropriate category for the purposes of this study. Sixty-three cases had follow-up histology, and malignancy rates for the Bethesda categories are as follows: Ben 17%, AFLUS 20%, SFN 29%, SM 83%, and Mal 100%. 28% of patients with AFLUS diagnosis received a repeat FNA. Ten patients received a molecular panel (BRAF, RAS, RET/PTC, Pax8/PPARγ) to aid in management decisions; based on negative molecular panels, 6 of 10 patients received clinical management only.
Conclusions: Our institution's percent of each FNA category per the Bethesda terminology was consistent with the literature, except for our 25% rate of AFLUS diagnoses, for which we may need to institute a quality control measure. In addition, our cytopathologists do not consistently use the Bethesda terminology, which likely results in confusion among clinicians and may affect patient care. We therefore recommend strict adherence to the Bethesda terminology, with description as needed. Furthermore, our rates of malignancy in patients with histologic follow-up are similar to those reported in the literature. Because only 28% of AFLUS-diagnosed patients are receiving a repeat FNA, we recommend a multi-disciplinary workshop to discuss patient management for each Bethesda category. Last, ancillary molecular testing indicates that, for our patient population, a molecular panel may be an excellent ancillary test in patients who do not desire surgery and have an AFLUS or SFN diagnosis.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 261, Monday Afternoon