Abstract
Objectives:
(1) Describe how thyroid molecular testing affects surgeon-performed ultrasound-guided fine-needle aspiration (FNA) with immediate on-site cytopathological interpretation. (2) Analyze percentage of inadequate FNA cytology (FNAC) and number of aspirations, comparing with and without surgeon-performed ultrasound guidance.
Methods:
Retrospective cohort comparison. A cytopathologist is present for on-site staining (Diff-Quik) adequacy evaluation and molecular testing triage. This is followed by pap stain, cell block, and liquid-based cytology. Cytological adequacy and number of aspirations for 200 consecutive patients undergoing surgeon-performed ultrasound-guided FNA are compared with a series from the same surgeon without ultrasound guidance. A questionnaire subjectively scoring anticipated and actual pain from 1 through 10 (10 severe) was recorded immediately before and after FNAC.
Results:
Patients with an inadequate FNAC, with and without ultrasound guidance, were 0% and 3% (P > .05). The mean number of aspirations with and without ultrasound guidance were 1.7 and 4.0 (P < .05). Using ultrasound guidance, benign, indeterminate, and malignant FNA results were 173 out of 200 (87%), 18 out of 200 (9%), and 9 out of 200 (4%). All indeterminate cytology (9%) underwent BRAF testing. Six out of 200 (3%) indeterminate FNAC underwent multigene expression testing. The mean anticipated versus actual discomfort experienced with surgeon-performed ultrasound-guided FNA was 5.3 and 1.9 (P < .05).
Conclusions:
Surgeon-performed ultrasound-guided FNAC with on-site cytopathology can largely eliminate inadequate FNA, potentially reducing the number of aspirations. Indeterminate FNAC can be triaged for molecular testing, performed in 9% of patients, potentially improving patient selection for surgery. The cytological interpretation can often be immediately communicated to the patient. Discomfort experienced is minimal.
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