Background: Fine-needle aspiration (FNA) may be the procedure of choice in the preoperative evaluation of thyroid nodules, yet it suffers as a modality both because of its inherent limitations as well as variability in its diagnostic terminology. The National Cancer Institute recently proposed a classification system. The objective of this study was to report our experience in using this new reporting system to review the distribution of diagnosis categories and to evaluate the specificity of the system based on the cytologic–histologic correlation. Patients and Methods: A total of 3207 thyroid nodules underwent FNA, that is, 3207 FNAs from 2468 patients were examined at our institution between January 1, 2008 and December 31, 2008. All FNAs were classified prospectively into unsatisfactory, benign, indeterminate (cells of undetermined significance), follicular neoplasm (FN), suspicious for malignancy, and positive for malignancy. Results: The distribution of these categories from 3207 evaluated nodules w...

The Bethesda Thyroid Fine-Needle Aspiration Classification System: Year 1 at an Academic Institution

Fine-needle aspiration (FNA) biopsy of thyroid nodules is minimally invasive and safe and is usually performed on an outpatient basis. However, the optimal application of FNA requires not only technical skill but also an awareness of the limitations of the procedure, the indications for its use, the factors that affect the adequacy of the biopsy specimen, and the postprocedural management strategy. Ultrasonographic (US) features that are considered indications for FNA include single and multiple thyroid nodules. The results of FNA biopsy are operator dependent. In addition, the results may be affected by the lesion characteristics, the accuracy of lesion and needle localization, the method of guidance, the number of aspirated samples, the needle gauge, the aspiration technique, and the presence or absence of on-site facilities for immediate cytologic examination. With regard to postprocedural management, nodules that are diagnosed as benign on the basis of an adequate FNA specimen should be monitored with...

https://pubs.rsna.org/doi/pdf/10.1148/rg.287085033

US-guided Fine-Needle Aspiration of Thyroid Nodules: Indications, Techniques, Results

Fine-needle aspiration biopsy (FNAB) of thyroid nodules is a safe, cost-effective procedure but the rates of inadequate cytology specimens range from approximately 1% to 15%. This study tests the hypothesis that ultrasonographically (US) guided FNAB and onsite assessment of cytology improves the adequacy rate of FNAB. A retrospective analysis was performed on 693 thyroid FNAB specimens obtained with and without ultrasound guidance and with or without onsite cytology assessment. Overall, 29 specimens (4%) were inadequate for diagnosis. Among 163 cystic nodules and 530 solid nodules, inadequacy rates were 15% (n = 24) and 1% (n = 5) respectively (p = 0.0001). An onsite assessment of cytology for adequacy was done in 550 cases (83%), which was more accurately performed by a cytopathologist (97%) than a cytotechnologist (93%, p = 0.015). With US-guided FNAB, 3% of the cytology specimens were inadequate, compared to a 7% rate when US was not done (p = 0.003). The mean number of needle punctures necessary for an adequate specimen was 3.8 +/- 0.06 (median, 3.0; range, 1-11), which was different among various types of doctors, ranging from 3.2 +/- 0.07 to 5.4 +/- 0.12 (p = 0.001 analysis of variance [ANOVA]). The fewest number of needle passes to achieve an adequate specimen were required by university endocrinologists and pathologists working together (average, 3.2 +/- 0.07; median, 3.0; range, 1-11). Sample inadequacy rate varied significantly among physician groups, ranging from 3% to 18% (p = 0.0001 ANOVA). Stepwise regression analysis showed that onsite assessment of cytology, US-guided FNAB (p = 0.16), and cystic nature of the nodule (p < 0.0001 for all) correlated with adequacy of the specimen. We conclude that US-guided FNAB with onsite evaluation of cytology specimens substantially increases the adequacy of cytology specimens and decreases the number of required needle passes, which ultimately reduces patient discomfort and diagnostic errors, thus raising the question as to whether this should eventually become the standard of care. We believe this is a goal that training programs should strive to achieve.

The impact of assessing specimen adequacy and number of needle passes for fine-needle aspiration biopsy of thyroid nodules

The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine-Needle Aspiration (FNA) State of the Science Conference on October 22-23, 2007 in Bethesda, MD. The 2-day meeting was accompanied by a permanent informational website and several on-line discussions between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes the indications for performing an FNA of a nodule discovered by physical examination or an imaging study; the indications for using ultrasound versus palpation for guidance when performing a thyroid FNA; the issues surrounding informed consent for thyroid FNA; and the information required on a requisition form that accompanies a thyroid FNA specimen. (http://thyroidfna.cancer.gov/pages/info/agenda/)

/pdf/indications-for-thyroid-fna-and-pre-fna-requirements-a-i5m000yviw.pdf

Indications for thyroid FNA and pre-FNA requirements: A synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference

Background Fine-needle aspiration cytology (FNAC) is commonly used as a diagnostic procedure to evaluate superficial and deep masses in animals. However, few studies have addressed the accuracy of FNAC in the evaluation of cutaneous and subcutaneous masses in a clinical setting. Objective The purpose of this study was to compare the accuracy of FNAC as compared with histopathology in the diagnosis of cutaneous and subcutaneous masses from dogs and cats. Methods Cytologic and histopathologic specimens obtained between 1999 and 2003 from 292 palpable cutaneous and subcutaneous masses obtained from 242 dogs and 50 cats were retrospectively evaluated. Cytologic samples were obtained by FNA and histopathologic samples were collected by surgical biopsy or at necropsy. Concordance was determined and the accuracy of FNAC for the diagnosis of neoplasia was determined using histopathology as the gold standard. Results Of 292 specimens, 49 (from 44 dogs and 5 cats) were excluded due to poor cellularity of the cytologic specimen (retrieval rate 83.2%, n = 243). A cytologic diagnosis of neoplasia was obtained in 176 cases (175 true positives and 1 false positive compared with histopathology). Sixty-seven cytology samples were classified as non-neoplastic (46 true negatives, 21 false negatives compared with histopathology). Overall, the cytologic diagnosis was in agreement with the histopathologic diagnosis in 90.9% (221/243) of cases. For diagnosing neoplasia, cytology had a sensitivity of 89.3%, a specificity of 97.9%, a positive predictive value of 99.4%, and a negative predictive value of 68.7%. Conclusions The results of this study confirmed FNAC as a reliable and useful diagnostic procedure for the evaluation of palpable cutaneous and subcutaneous lesions in small animal practice.

Correlation between fine-needle aspiration cytology and histopathology in the evaluation of cutaneous and subcutaneous masses from dogs and cats.

This guideline document was developed by the Standards of Practice Task Force of the Papanicolaou Society of Cytopathology, based on extensive literature reviews and the personal practical experience of task force members. The draft guidelines were then subjected to expert review. The task force made revisions to the drafts based on the responses received from the consultant members, who are recognized experts in fine‐needle aspiration biopsy. Diagn. Cytopathol. 1997;17:239–247. © 1997 Wiley‐Liss, Inc.

/pdf/guidelines-of-the-papanicolaou-society-of-cytopathology-for-42p0liwic5.pdf

Guidelines of the Papanicolaou Society of Cytopathology for Fine-Needle Aspiration Procedure and Reporting

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Guidelines of the Papanicolaou Society of Cytopathology for Fine-Needle Aspiration Procedure and Reporting