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Donmez M, Aydin H, Kose E, Kahramangil B, Erten O, Gokceimam M, Akbulut S, Jin J, Krishnamurthy V, Shin J, Siperstein A, Berber E. Standardization of thyroid fine needle aspiration procedure and outcomes within an endocrine surgery department. Gland Surg 2021; 10:567-573. [PMID: 33708540 DOI: 10.21037/gs-20-630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Fine needle aspiration (FNA) biopsy is an essential procedure for thyroid nodules. Although, the efficacy of surgeon-performed thyroid FNA biopsies has been demonstrated in the literature, there are insufficient data regarding how to establish an efficient program with a low insufficiency rate within a group practice. Methods An endocrine surgery thyroid FNA biopsy program was established in 2000 by one surgeon, with training of additional partners during fellowship and upon recruitment. The results within 18 years were analyzed. The FNA biopsies were performed by endocrine surgeons under ultrasound guidance without on-site pathologist review. Results A total of 5,469 FNA biopsies were performed by 7 surgeons. The total number of FNA biopsies performed by each surgeon varied between 291-1,378. FNA biopsies were performed in 2 passes using 22-gauge needles under constant suction. The overall insufficiency rate was 4.3%, with individual surgeon rates ranging between 2.7% and 7.2%. The insufficiency rate for the whole team ranged between 3.3% and 5% when examined in 5-year blocks. Conclusions This study shows that an establishment of a highly efficient thyroid FNA biopsy program within a group practice is possible with a structured endocrine surgical training and adoption of a standard technique.
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Affiliation(s)
- Mustafa Donmez
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Husnu Aydin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Emin Kose
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Bora Kahramangil
- Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Ozgun Erten
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Mehmet Gokceimam
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Serkan Akbulut
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Judy Jin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joyce Shin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Allan Siperstein
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
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Rowley S, Clare S. How widely has ANTT been adopted in NHS hospitals and community care organisations in England and Scotland? ACTA ACUST UNITED AC 2020; 29:924-932. [DOI: 10.12968/bjon.2020.29.16.924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: To the detriment of patient safety, the important clinical competency of aseptic technique has been notoriously variable in practice, and described ambiguously in the literature, internationally. From a UK perspective, attempts have been made to improve patient safety by reducing variability and improving education and practice through standardisation. The Welsh Government mandated Aseptic Non Touch Technique (ANTT®) as a specific national standard in 2015. All healthcare organisations in England are required by the Health and Social Care Act 2008 to have a single standard aseptic technique, demonstrable by the clinical governance indicators of education, training, competency assessment and compliance audit. In Scotland, an education-based initiative was launched by NHS Education for Scotland in 2012. To review the impact of these and other initiatives on the current status of aseptic technique, all NHS trusts in England and NHS health boards in Scotland were assessed under the Freedom of Information procedure. Findings: 93% of NHS trusts in England use a single standard for aseptic technique. In 88% of these trusts the single standard was stipulated as being ANTT. In Scotland, 62% of NHS acute and community care hospitals within health boards use a single standard. In 56% of these, the single standard was ANTT. When including those that use ANTT in combination with other techniques ANTT usage is 73%. Conclusion: These data demonstrate significant progress in standardising aseptic technique education, assessment and governance, and confirms ANTT as the de facto aseptic technique used in NHS trusts in England and health boards in Scotland.
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Affiliation(s)
- Stephen Rowley
- Clinical Director, The Association for Safe Aseptic Practice
| | - Simon Clare
- Research and Practice Development Director, The Association for Safe Aseptic Practice
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3
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Flatman S, Kwok MMK, Magarey MJR. Introduction of
surgeon‐performed
ultrasound to a head and neck clinic: indications, diagnostic adequacy and a new clinic model? ANZ J Surg 2020; 90:861-866. [DOI: 10.1111/ans.15886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 03/11/2020] [Accepted: 03/15/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Samuel Flatman
- Head and Neck Surgical OncologyPeter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Matthew Ming Kei Kwok
- Head and Neck Surgical OncologyPeter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Matthew J. R. Magarey
- Head and Neck Surgical OncologyPeter MacCallum Cancer Centre Melbourne Victoria Australia
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4
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García Pascual L, Surralles ML, Morlius X, González Mínguez C, Viscasillas G, Lao X. Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination: Diagnostic efficacy, prevalence, and factors predicting for Bethesda category I results. ACTA ACUST UNITED AC 2019; 66:495-501. [PMID: 30858021 DOI: 10.1016/j.endinu.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/14/2018] [Accepted: 12/21/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination may decrease the number of Bethesda categoryI cytologies. The study objective was to evaluate our second-year experience with this procedure to analyze diagnostic efficacy, prevalence, and factors predicting for Bethesda categoryI results. PATIENTS AND METHOD A retrospective study was conducted of 279 nodules from 233 patients. Ultrasound -guided fine needle aspiration was performed according to the 2015 criteria of the American Thyroid Association. A specimen of each aspiration was air-fixed on site before Diff-Quik staining and microscopic examination to assess its suitability; otherwise, nodule aspiration was repeated up to 5times. Diagnostic efficacy was assessed based on sensitivity and specificity on the cytological categories BethesdaII and BethesdaVI. RESULTS Diagnostic sensitivity and specificity were both 100%, 5.4% Bethesda categoryI results were obtained, and variables independently associated were age (4.7% increase per year of life) and nodule volume (2.3% increase per each 1mL of volume). CONCLUSIONS Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination allows for a high diagnostic efficacy and has been shown to be a highly relevant procedure because it has a very low rate of cytological results of Bethesda categoryI, whose risk has been higher in older subjects and with larger nodules.
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Affiliation(s)
- Luis García Pascual
- Servicio de Endocrinología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.
| | - Maria Lluïsa Surralles
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Xavier Morlius
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Clarisa González Mínguez
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Guillem Viscasillas
- Servicio de Otorrinolaringología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Xavier Lao
- Servicio de Otorrinolaringología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
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5
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Pastorello RG, Destefani C, Pinto PH, Credidio CH, Reis RX, Rodrigues TDA, Toledo MCD, De Brot L, Costa FDA, Nascimento AG, Pinto CAL, Saieg MA. The impact of rapid on‐site evaluation on thyroid fine‐needle aspiration biopsy: A 2‐year cancer center institutional experience. Cancer Cytopathol 2018; 126:846-852. [DOI: 10.1002/cncy.22051] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | - Camila Destefani
- Department of Pathology A.C. Camargo Cancer Center Sao Paulo Brazil
| | - Pedro H. Pinto
- Department of Pathology A.C. Camargo Cancer Center Sao Paulo Brazil
- Department of Pathology Base Hospital Federal District Brazil
| | | | - Rafael X. Reis
- Department of Pathology A.C. Camargo Cancer Center Sao Paulo Brazil
| | | | | | - Louise De Brot
- Department of Pathology A.C. Camargo Cancer Center Sao Paulo Brazil
| | | | | | | | - Mauro A. Saieg
- Department of Pathology A.C. Camargo Cancer Center Sao Paulo Brazil
- Department of Pathology Santa Casa Medical School Sao Paulo Brazil
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Penín M, Martín MÁ, San Millán B, García J. Learning curve of thyroid fine-needle aspiration biopsy. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2017. [DOI: 10.1016/j.endien.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Curva de aprendizaje de la punción aspiración con aguja fina de tiroides. ENDOCRINOL DIAB NUTR 2017; 64:539-543. [DOI: 10.1016/j.endinu.2017.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/26/2017] [Accepted: 07/05/2017] [Indexed: 02/06/2023]
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8
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Chong Y, Ji SJ, Kang CS, Lee EJ. Can liquid-based preparation substitute for conventional smear in thyroid fine-needle aspiration? A systematic review based on meta-analysis. Endocr Connect 2017; 6:817-829. [PMID: 29018157 PMCID: PMC5682413 DOI: 10.1530/ec-17-0165] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/10/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Conventional smear (CS) using fine-needle aspiration cytology (FNAC) has been established as the test of choice for diagnosing thyroid lesions, despite low sample adequacy and inter-individual variations. Although a liquid-based preparation (LBP) technique has been recently applied to overcome these limitations, its clinical utility and its accuracy over CS are controversial. This study aimed to determine the true sensitivity and specificity of LBP in thyroid FNAC by meta-analysis. DESIGN Systematic review with meta-analysis. METHODS We searched major electronic databases (MEDLINE, EMBASE, Cochrane library, Google Scholar) with queries of 'thyroid', 'LBP' and 'liquid-based cytology'. Original articles including cytohistologic correlation data comparing the accuracy of any LBP technique, such as ThinPrep, SurePath and Liqui-Prep, with CS were included for qualitative meta-analysis and preparation of synthesized reporter-operating curves (sROC). RESULTS A total of 372 studies were screened and 51 original articles were eligible for full-text review; finally, 24 studies were chosen for the meta-analysis. Average sample inadequacy was significantly lower in two mainstream LBP methods (ThinPrep and SurePath) than CS. Specificity and sensitivity by sROC were similar or slightly superior for LBP vs CS. Various cytomorphologic changes by each method have been reported. CONCLUSIONS Although a learning curve is essential for adapting to the cytomorphologic features of the LBP technique, our results support the use of two mainstream LBPs alone in thyroid FNAC that LBP will increase the sample adequacy and reduce the workload with similar accuracy. More data and further evaluation are needed for the other LBP methods.
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Affiliation(s)
- Yosep Chong
- Department of Hospital PathologyCollege of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soon-Jin Ji
- Medical LibraryThe Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Suk Kang
- Department of Hospital PathologyCollege of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Jung Lee
- Department of Hospital PathologyCollege of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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9
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Medina Chamorro FM, Calle JA, Stein JE, Merchancano L, Mendoza Briñez AM, Pulido Wilches AA. Experience of the Implementation of Rapid On-Site Evaluation in Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules. Curr Probl Diagn Radiol 2017; 47:220-224. [PMID: 28734572 DOI: 10.1067/j.cpradiol.2017.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the effect of the implementation of the rapid on-site evaluation (ROSE) technique in ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. MATERIALS AND METHODS We conducted an observational and retrospective study approved by the Institutional Ethics Committee as an investigation without risk. Between January 2012 and December 2015, 892 ultrasound-guided fine-needle aspiration biopsy procedures were performed under ultrasound guidance. In our study, we included 522 procedures from 473 patients that were taken as part of an investigation of the thyroid nodule (average age: 56 ± 14; 84% were women). We compared the percentage of unsatisfactory samples in the procedures performed with and without the use of the ROSE technique, the cytology adequacy agreement with the cytopathology, and we also assessed the relationship with the number of years of experience of the radiologist. RESULTS The ROSE technique led to a decrease of 30.5% of unsatisfactory samples. By 2014, more than half of the procedures were performed with the ROSE technique, and the percentage of unsatisfactory samples decreased progressively each year. The technical implementation of ROSE improved the results of all radiologists; however, those radiologists with the least number of years of experience showed the greatest benefits from the implementation of the ROSE technique. The concordance between the ROSE technique and the cytopathology report was good (Cohen κ = 0.75). CONCLUSION In our experience, the implementation of the ROSE technique has helped to reduce the percentage of unsatisfactory samples, which improves the quality and safety of patient care.
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Affiliation(s)
| | - José Abella Calle
- Department of Radiology and Diagnostic Imaging, Fundación Valle del Lili, Cali, Colombia
| | | | - Lina Merchancano
- Deparment of Radiology and Diagnostic Imaging, Clinical Research Center, Fundación Valle del Lili, Cali, Colombia.
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10
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de Koster EJ, Kist JW, Vriens MR, Borel Rinkes IHM, Valk GD, de Keizer B. Thyroid Ultrasound-Guided Fine-Needle Aspiration: The Positive Influence of On-Site Adequacy Assessment and Number of Needle Passes on Diagnostic Cytology Rate. Acta Cytol 2016; 60:39-45. [PMID: 26982029 DOI: 10.1159/000444917] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/22/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Nondiagnostic cytology is the most important limitation of thyroid ultrasound-guided fine-needle aspiration (US-FNA). This study aimed to identify factors associated with the adequacy rate of thyroid US-FNA. STUDY DESIGN Consecutive thyroid US-FNAs (2006-2013) were retrospectively included. Attending radiologists, radiology fellows and radiology residents performed US-FNA, usually involving 2-3 needle passes. In more recent years, rapid on-site adequacy assessment (ROSAA) was performed to ensure specimen adequacy. US characteristics, procedural variations and cytology results were extracted from US and pathology reports and statistically evaluated. RESULTS Diagnostic cytology was obtained in 64.6% of 1,381 thyroid US-FNAs. Factors associated with nondiagnostic cytology were ROSAA (74.6% diagnostic cytology, OR 0.55, 95% CI 0.42-0.71), ≥3 clinic visits for US-FNA of the same thyroid nodule (54.7%, OR 1.56, 95% CI 1.16-2.10) and increased intranodular vascularization (51.8%, OR 1.73, 95% CI 1.17-2.57). With ROSAA, an increasing number of needle passes demonstrated improving adequacy rates. The adequacy rate was not operator-dependent. CONCLUSION This study demonstrates that ROSAA improves the adequacy rate of thyroid US-FNA. Without ROSAA, we recommend performing at least 3 needle passes. Less diagnostic cytology is obtained from nodules with increased intranodular vascularization or from those undergoing US-FNA ≥3 times.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Fernandes VT, De Santis RJ, Enepekides DJ, Higgins KM. Surgeon-performed ultrasound guided fine-needle aspirate biopsy with report of learning curve; a consecutive case-series study. J Otolaryngol Head Neck Surg 2015; 44:42. [PMID: 26510834 PMCID: PMC4625451 DOI: 10.1186/s40463-015-0099-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
Background Fine-needle aspiration biopsy has become the standard of care for the evaluation of thyroid nodules. More recently, the use of ultrasound guided fine-needle aspiration biopsy (UG-FNAB) has improved adequacy of sampling. Now there has been improved access to UG-FNAB as ultrasound technology has become more accessible. Here we review the adequacy rate and learning curve of a single surgeon starting at the adoption of UG-FNAB into surgical practice. Methods UG-FNABs performed at Sunnybrook Health Sciences Centre from 2010 to 2015 were reviewed retrospectively. Nodule characteristics were recorded along with cytopathology and final pathology reports. Chi-square analysis, followed by the reporting of odds ratios with confidence intervals, were used to assess the statistical significance and frequencies, respectively, of nodule characteristics amongst both diagnostic and non-diagnostic samples. A multiple regression analysis was conducted to determine if any nodule characteristic were predictive of adequacy of UG-FNABs. The learning curve was assessed by calculating the eventual adequacy rates across each year, and its statistical significance was measured using Fischer’s Exact Test. Results In total 423 biopsies were reviewed in 289 patients. The average nodule size was 23.05 mm. When examining if each patient eventually received a diagnostic UG-FNAB, regardless of the number attempts, adequacy was seen to increase from 70.8 % in 2010 to, 81.0 % in 2011, 90.3 % in 2012, 85.7 % in 2013, 89.7 % in 2014, and 94.3 % in 2015 (Fischer’s Exact Test, p = 0.049). Cystic (χ2 = 19.70, p <0.001) nodules were found to yield higher rates of non-diagnostic samples, and their absence are predictive of obtaining an adequate biopsy as seen in a multiple regression analysis (p < 0.001) Adequacy of repeat biopsies following an initial non-diagnostic sample was 75.0 %. Conclusions Surgeons are capable of performing UG-FNAB with a learning curve noted to achieve standard adequacy rates. Cystic nodules are shown to yield more non-diagnostic samples in the surgeon’s office.
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Affiliation(s)
- Vinay T Fernandes
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada.
| | - Robert J De Santis
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada.
| | - Danny J Enepekides
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada
| | - Kevin M Higgins
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada.
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12
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The Development of a Validated Checklist for Ultrasound-Guided Thyroid Nodule Fine-Needle Aspiration Biopsies. Ultrasound Q 2015; 31:159-65. [DOI: 10.1097/ruq.0000000000000137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Fernandes VT, Magarey MJR, Kamdar DP, Freeman JL. Surgeon performed ultrasound-guided fine-needle aspirates of the thyroid: 1067 biopsies and learning curve in a teaching center. Head Neck 2015; 38 Suppl 1:E1281-4. [PMID: 26316053 DOI: 10.1002/hed.24212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 06/12/2015] [Accepted: 07/11/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Surgeon performed ultrasound-guided fine-needle aspirates (UG-FNAs) reduce delay in diagnosis and allow for surgeon surveillance. We present the first report on a learning curve and impact of head and neck surgical trainees on adequacy rates. METHODS Thyroid UG-FNA biopsies from 2009 to 2013 were reviewed retrospectively. Specimen adequacy, cytologic diagnosis, and surgical pathology were used to calculate adequacy and accuracy. RESULTS One thousand sixty-seven biopsies were examined in 723 individuals. The adequacy rate from adoption into practice improved from 71% to 78% to 85% over 300 cases. When UG-FNA was subsequently taught to trainees, adequacy rates varied among trainees (p < .037), and there were higher nondiagnostic rates earlier in training (p = .04). Adequacy was not related to size or palpability, but cystic lesions yielded more inadequate specimens (p < .001). CONCLUSION Surgeon performed UG-FNA biopsy can be performed adequately in an outpatient setting. Adequacy rates reach acceptable levels after 300 cases, whereas trainee involvement impacts adequacy rates. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1281-E1284, 2016.
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Affiliation(s)
- Vinay T Fernandes
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Dev P Kamdar
- Hofstra North Shore - LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Jeremy L Freeman
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Canada
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14
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Bellevicine C, Vigliar E, Malapelle U, Pisapia P, Conzo G, Biondi B, Vetrani A, Troncone G. Cytopathologists can reliably perform ultrasound-guided thyroid fine needle aspiration: a 1-year audit on 3715 consecutive cases. Cytopathology 2015; 27:115-21. [PMID: 25810099 DOI: 10.1111/cyt.12243] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE In our Pathology Department, fine needle aspiration (FNA) of palpable thyroid nodules is performed by cytopathologists who ensure correct sample management and rapid on-site evaluation (ROSE). Conversely, ultrasound (US)-guided FNAs have traditionally been carried out by endocrinologists and radiologists in outside clinics, where the presence of a cytopathologist is not always feasible. To overcome this limitation, cytopathologists have started to perform US-guided FNAs themselves. This study retrospectively evaluates 1 year of this novel practice. METHODS A total of 2225 US-guided FNAs were performed in our clinic by cytopathologists, whereas 1490 aspirates were taken by a group of non-cytopathologists. Among these, 756 FNAs were taken by a single experienced endocrinologist. The distribution of the Bethesda classification categories was evaluated in each of these groups. RESULTS FNAs performed by cytopathologists were more often diagnostic and better prepared than those taken by non-cytopathologists, including those taken by the experienced endocrinologist (P < 0.01). The latter operator yielded a higher rate of suspicious and malignant FNAs, reflecting a more appropriate clinical triage of worrisome nodules. CONCLUSION Although the endocrinologist's evaluation is crucial to select clinically relevant thyroid nodules, cytopathologists can reliably perform US guidance in addition to their traditional expertise in sampling, specimen preparation and ROSE.
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Affiliation(s)
- C Bellevicine
- Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy
| | - E Vigliar
- Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy
| | - U Malapelle
- Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy
| | - P Pisapia
- Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy
| | - G Conzo
- Department of Anesthesiologic, Surgical and Emergency Sciences, VII Division of General and Endocrine Surgery, Second University of Naples, Naples, Italy
| | - B Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - A Vetrani
- Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy
| | - G Troncone
- Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy
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15
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Lee YH, Baek JH, Jung SL, Kwak JY, Kim JH, Shin JH. Ultrasound-guided fine needle aspiration of thyroid nodules: a consensus statement by the korean society of thyroid radiology. Korean J Radiol 2015; 16:391-401. [PMID: 25741201 PMCID: PMC4347275 DOI: 10.3348/kjr.2015.16.2.391] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/15/2014] [Indexed: 12/11/2022] Open
Abstract
Ultrasound (US)-guided fine needle aspiration (US-FNA) has played a crucial role in managing patients with thyroid nodules, owing to its safety and accuracy. However, even with US guidance, nondiagnostic sampling and infrequent complications still occur after FNA. Accordingly, the Task Force on US-FNA of the Korean Society of Thyroid Radiology has provided consensus recommendations for the US-FNA technique and related issues to improve diagnostic yield. These detailed procedures are based on a comprehensive analysis of the current literature and from the consensus of experts.
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Affiliation(s)
- Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 425-707, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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16
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Witt BL, Schmidt RL. Rapid onsite evaluation improves the adequacy of fine-needle aspiration for thyroid lesions: a systematic review and meta-analysis. Thyroid 2013; 23:428-35. [PMID: 23043247 DOI: 10.1089/thy.2012.0211] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Fine-needle aspiration (FNA) with ultrasonography guidance is one of the optimal techniques for the diagnostic evaluation of thyroid nodules. A significant subset of thyroid FNAs continues to be inadequate for interpretation, which potentially leads to increased costs from repeat aspirations. Numerous studies have been published regarding the influence of rapid onsite evaluation (ROSE) by cytopathologists on thyroid FNAs, some indicating that FNA is more likely to be adequate for interpretation with ROSE, while others refute this idea. To our knowledge, no meta-analysis of the literature on this subject has been undertaken. METHODS We searched MEDLINE and EMBASE using the following search string: (needle biopsy) AND (assessment or onsite OR onsite or immediate or rapid)/title or abstract. There were no restrictions on study design, language, anatomic site, or time period. Only studies comparing two arms (with/without ROSE) at a single site were eligible for inclusion. Potentially relevant studies were subjected to a citation search (forward search) and reference search (backward search) using SCOPUS. Statistical calculations were performed using Stata Release 12. Meta-analysis was completed using a random-effect model as implemented in the metan routine in Stata. RESULTS An initial search obtained 2179 studies from MEDLINE and EMBASE, and screening yielded 71 potentially relevant studies. A focused review of this subset resulted in seven full studies and one abstract that met our inclusion criteria. Our citation search using SCOPUS yielded no new studies. Overall, the average adequacy rate was 83% without ROSE compared to 92% with ROSE. Visual inspection of the data suggested that the improvement in adequacy due to ROSE may be related to the adequacy rate without ROSE. Metaregression analysis showed that the change in the adequacy rate was strongly correlated (t=-12.7, p<0.001) with the non-ROSE adequacy rate. In addition, the non-ROSE adequacy rate explained all, but 10% of the residual between study variability in the change in the adequacy rates due to ROSE. CONCLUSIONS ROSE is generally associated with an improvement in adequacy, but the impact of ROSE depends heavily on the initial adequacy rate. Sites with lower initial adequacy rates can benefit the most from the implementation of ROSE.
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Affiliation(s)
- Benjamin L Witt
- Department of Anatomic Pathology, University of Utah School of Medicine/ARUP Laboratories, Salt Lake City, Utah 84112, USA.
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Naïm C, Karam R, Eddé D. Ultrasound-guided fine-needle aspiration biopsy of the thyroid: methods to decrease the rate of unsatisfactory biopsies in the absence of an on-site pathologist. Can Assoc Radiol J 2012; 64:220-5. [PMID: 22867963 DOI: 10.1016/j.carj.2012.03.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 02/11/2012] [Accepted: 03/09/2012] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The rate of unsatisfactory samples from ultrasound-guided fine-needle aspirations of thyroid nodules varies widely in the literature. We aimed to evaluate our thyroid ultrasound-guided fine-needle aspiration biopsy technique in the absence of on-site microscopic examination by a pathologist; determine factors that affect the adequacy rate, such as the number of needle passes and needle size; compare our results with the literature; and establish an optimal technique. MATERIALS AND METHODS We performed a retrospective review of cytopathology reports from 252 consecutive thyroid ultrasound-guided fine-needle aspiration biopsies performed by a radiologist between 2005 and 2010 in our hospital's radiology department. Sample adequacy, the number of needle passes, and needle size were determined. There was an on-site cytologist who prepared slides immediately after fine-needle aspiration but no on-site microscopic assessment of sample adequacy to guide the number of needle passes that should be performed. Cytopathology biopsy reports were classified as either unsatisfactory or satisfactory samples for diagnosis; the latter consisted of benign, malignant, and undetermined diagnoses. RESULTS Seventy-seven biopsies were performed with 1 needle pass, 124 with 2 needle passes, and 51 with 3 needle passes. The rates of unsatisfactory biopsies were 33.8%, 23.4% (odds ratio [OR] 0.599 [95% confidence interval {CI}, 0.319-1.123]; P = .110), and 13.7% (OR 0.312 [95% CI, 0.124-0.788]; P = .014), respectively. CONCLUSION In a hospital in which there is no on-site pathologist, a 3-pass method increases the specimen satisfactory rate by 20% compared with 1 pass, achieves similar rates to the literature, and provides a basis for further improvement of our practice.
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Affiliation(s)
- Cyrille Naïm
- University of Montreal Hospital Center, University of Montreal Faculty of Medicine, Montreal, Quebec, Canada.
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Olson MT, Tatsas AD, Ali SZ. Cytotechnologist-attended on-site adequacy evaluation of thyroid fine-needle aspiration: comparison with cytopathologists and correlation with the final interpretation. Am J Clin Pathol 2012; 138:90-5. [PMID: 22706863 DOI: 10.1309/ajcp84axsrabzctz] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Recent increases in the number of thyroid fine-needle aspiration (FNAs) biopsies and the popularity of on-site evaluation for adequacy (OSEA) have led many practices, including ours, to rely on cytotechnologists for performing OSEA. We retrospectively analyzed the accuracy of a cytotechnologist against that of a cytopathologist in performing OSEA and making the final diagnosis. Of 2,261 thyroid FNA specimens evaluated over a 33-month period under ultrasound guidance with OSEA, the cytotechnologist attended 64.7% (1,462/2,261) of the procedures whereas the cytopathologist attended 35.3% (799/2,261). There was no difference in the adequacy downgrade rate for cytotechnologists compared with that for cytopathologists during this study period (4.1% vs 5.0% downgrade rate, P = .33). Regardless of who rendered the OSEA, subadequate specimens had a higher rate of indeterminate diagnosis (25.2%) than those specimens deemed adequate at the time of OSEA (11.9%, P = .00001). These results indicate that the accuracy of cytotechnologists is comparable with that of cytopathologists in conducting OSEA of the thyroid.
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Moore HM, Kelly AB, Jewell SD, McShane LM, Clark DP, Greenspan R, Hayes DF, Hainaut P, Kim P, Mansfield E, Potapova O, Riegman P, Rubinstein Y, Seijo E, Somiari S, Watson P, Weier HU, Zhu C, Vaught J. Biospecimen reporting for improved study quality (BRISQ). J Proteome Res 2011; 10:3429-38. [PMID: 21574648 PMCID: PMC3169291 DOI: 10.1021/pr200021n] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Human biospecimens are subject to a number of different collection, processing, and storage factors that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research utilizing human tissues, it is critical that information regarding the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications around biospecimen-related research and help reassure patient contributors and the advocacy community that the contributions are valued and respected.
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Affiliation(s)
- Helen M Moore
- Office of Biorepositories and Biospecimen Research, National Cancer Institute, Bethesda, Maryland, USA
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Choi SH, Han KH, Yoon JH, Moon HJ, Son EJ, Youk JH, Kim EK, Kwak JY. Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf) 2011; 74:776-82. [PMID: 21521280 DOI: 10.1111/j.1365-2265.2011.04011.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE The aim of this study was to evaluate the overall ultrasonographic features and clinical factors that contribute to inadequate sampling in ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules. MATERIALS AND METHODS From April 2008 to December 2008, 4077 US-FNABs in 3767 consecutive patients were reviewed. We evaluated the clinical, ultrasound and pathological features of patients and analysed the association between these features and inadequate samples. We also compared inadequate sample rates according to the experience of the performing doctor. RESULTS The inadequate sample rate was 16·1% (654/4077). Univariate analysis revealed an association between inadequate samples and cyst dominancy, macrocalcification and benign pathology of the nodule. The inadequate sample rate was also higher in the inexperienced group than in the experienced group. In multivariate analysis, cyst dominancy and macrocalcification of a nodule were significantly associated with inadequate samples in the experienced group. CONCLUSION Cyst dominancy and macrocalcifications in thyroid nodules, inexperience of the performing doctor and benign pathology were factors associated with high inadequate sample rates of US-FNAB in thyroid nodules.
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Affiliation(s)
- Seon Hyeong Choi
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Moon HJ, Kwak JY, Kim EK, Kim MJ. Ultrasonographic characteristics predictive of nondiagnostic results for fine-needle aspiration biopsies of thyroid nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:549-555. [PMID: 21420581 DOI: 10.1016/j.ultrasmedbio.2011.01.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 01/17/2011] [Accepted: 01/20/2011] [Indexed: 05/30/2023]
Abstract
The objective of this study was to identify clinical and ultrasonographic (US) characteristics predictive of nondiagnostic results. An experienced radiologist performed an US-guided fine-needle aspiration biopsy (US-FNA) for 1493 thyroid nodules in 1419 patients. Cytological results were classified as nondiagnostic (<6 groups of cells containing more than 10 cells) or diagnostic. The clinical characteristics of patients and the US features of thyroid nodules were compared according to nondiagnostic or diagnostic results. Age and sex were not associated with nondiagnostic results. A cystic portion >50% and hypoechogenicity were independent factors for predicting nondiagnostic results in all nodules (odds ratios [OR] = 2.82 and 1.88, respectively). In 534 nodules with more than 50% of cystic portion, the size of more than 10 mm and in 813 solid nodules, the size of 5 mm or smaller increased the likelihood of nondiagnostic results (ORs = 3.61 and 1.88, respectively).
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Affiliation(s)
- Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Moore HM, Kelly A, Jewell SD, McShane LM, Clark DP, Greenspan R, Hainaut P, Hayes DF, Kim P, Mansfield E, Potapova O, Riegman P, Rubinstein Y, Seijo E, Somiari S, Watson P, Weier HU, Zhu C, Vaught J. Biospecimen Reporting for Improved Study Quality. Biopreserv Biobank 2011; 9:57-70. [PMID: 21826252 DOI: 10.1089/bio.2010.0036] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 01/11/2011] [Indexed: 01/07/2023] Open
Abstract
Human biospecimens are subject to a number of different collection, processing, and storage factors that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research utilizing human tissues, it is critical that information regarding the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The Biospecimen Reporting for Improved Study Quality guidelines are proposed as an important and timely resource tool to strengthen communication and publications around biospecimen-related research and help reassure patient contributors and the advocacy community that the contributions are valued and respected.
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