Ultrasound Guided Fine Needle Aspiration (US-FNA) of Thyroid Nodules by a Cytopathologist at the University of Toledo Medical Center. Lessons from a Northwest Ohio Hospital
Sri Krishna Chaitanya Arudra, Stacy L Molnar, Luis E De Las Casas. University of Toledo Medical Center, Toledo, OH
Background: The current state of the art method to sample thyroid nodules is by ultrasound guided fine needle aspiration (US-FNA). Our study evaluated the accuracy, safety, and results when this diagnostic modality is managed by an interventional cytopathologist.
Design: Thyroid US-FNAs performed by a cytopathologist between October 2010 and September 2012 were retrospectively reviewed. Clinical data, ultrasound features, duration of the procedure, number of passes, complications, adequacy, diagnosis, histologic correlation, and turn around times were analyzed. The aspirated material was obtained using a combination of Swedish and American methods with a 25 G x 1½ needle. Smears were stained for immediate evaluation with Diff-Quik. Additional smears were fixed in alcohol for Papanicolaou stain. Preliminary interpretations were incorporated in our clinical portal computer system within 2 hours after the procedure. The reports included a final diagnosis, Bethesda guidelines recommendations, clinical data, laboratory test results, ultrasound findings, procedure notes, and a microscopic description.
Results: A total of 164 thyroid US-FNAs from 112 patients were evaluated. The size of the nodules ranged from 0.5 to 7.5 cm with an average size of 2 cm. The average duration of the procedure was 45 minutes. Nodules were sampled an average of 3 times with the number of passes ranging from 1 to 5. The minor complication of a small hematoma occurred in 1 case (0.6%). All samples were adequate for evaluation. Of the 164 cases, 134 (82%) were benign, 25 (15%) were atypical/borderline, and 5 (3%) were malignant. There were 8 (6%) cytologically benign cases with tissue correlation, all which were histologically confirmed as such. Of the 25 atypical/borderline cases, 13 (52%) had tissue correlation. This included 10 cases of nodular hyperplasia with superimposed Hürthle cell metaplasia, 2 cases with radiation changes, and 1 case of metastatic leiomyosarcoma. Of the 5 malignant cases, 4 (80%) had tissue correlation. In every case the cytologic diagnosis was confirmed, including 1 case of metastatic leiomyosarcoma and 3 cases of papillary thyroid carcinoma. A final diagnosis was reported in 94% of the cases within 2 business days with the majority (69%) of those cases being reported in one business day or less.
Conclusions: Using a personalized multidisciplinary approach US-FNA performed by an interventional cytopahtologist can be a particularly safe, accurate, fast, and effective diagnostic modality.
Tuesday, March 5, 2013 8:30 AM
Proffered Papers: Section F, Tuesday Morning