Comparison of Diagnostic Rates and Concordance with Subsequent Surgical Resections between Conventional Smear and ThinPrep Preparations versus ThinPrep Only in Thyroid Fine Needle Aspiration (T-FNA) Specimens.
Miguel Rufail, Xin Jing, Brian Smola, Amer Heider, Richard Cantley, Judy C Pang, Madelyn Lew
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引用次数: 2
Abstract
Background: Thyroid fine needle aspiration (T-FNA) is a mainstay in management of thyroid nodules. However, the preparation of T-FNA specimens varies across institutions. Prior studies have compared diagnostic rates between different specimen preparations of T-FNA specimens and their associated advantages and disadvantages. However, few have compared the rates of all diagnostic categories of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) between liquid-based preparations (LBPs) and a combination of LBP and conventional smear (CS) preparations. Our study compares TBSRTC diagnostic rates between these 2 cohorts and correlates cytologic diagnoses with subsequent thyroid resections to evaluate rates of neoplasia (RON) and malignancy (ROM).
Methods: 584 consecutive thyroid FNA specimens were collected and stratified by preparation type (ThinPrep [TP] vs. CS & TP). Diagnostic rates for each TBSRTC diagnostic category were calculated. The institution's electronic medical records database was searched for histologic diagnoses of previously sampled thyroid nodules to evaluate the RON and ROM.
Results: Of 584 thyroid FNA specimens, 73 (12.5%) and 511 (87.5%) were evaluated by TP only and CS & TP, respectively, reflecting the predominance of rapid on-site evaluation (ROSE) with CS for T-FNAs at our institution. Of the TP only and CS & TP cohorts, 29 (39.7%) and 98 (19.2%) had subsequent resections, respectively. The frequency of non-diagnostic cases was lower in the CS & TP cohort (12.7% vs. 26%). While the diagnostic rate of follicular lesion of undetermined significance was similar for both cohorts, SFN categorization was only utilized in the CS & TP cohort (1.5% vs. 0%). Although RON and ROM were similar between cohorts in many of the TBSRTC categories, there was a higher RON associated with non-diagnostic specimens in the TP only cohort when the denominator included all non-diagnostic cases.
Conclusion: The combination of CS and LBP may potentially decrease the non-diagnostic rate of T-FNA specimens as well as the number of passes required for diagnosis, particularly with ROSE. Evaluation of morphologic features highlighted in conventional smears may facilitate diagnostic categorization in the "suspicious for follicular neoplasm" category.
背景:甲状腺细针穿刺(T-FNA)是治疗甲状腺结节的主要方法。然而，T-FNA标本的制备因机构而异。已有研究比较了T-FNA不同标本制备方法的诊断率及其优缺点。然而，很少有人比较Bethesda甲状腺细胞病理学报告系统(TBSRTC)中液体基制剂(LBP)和LBP与常规涂片制剂(CS)组合的所有诊断类别的比率。我们的研究比较了这两个队列的TBSRTC诊断率，并将细胞学诊断与随后的甲状腺切除术相关联，以评估肿瘤(RON)和恶性(ROM)的发生率。方法:连续采集584例甲状腺FNA标本，按制剂类型(ThinPrep [TP] vs. CS &TP)。计算TBSRTC各诊断类别的诊断率。结果:584例甲状腺FNA标本中，73例(12.5%)和511例(87.5%)只进行了TP和CS评估;TP，分别反映了我们机构使用CS对T-FNAs进行快速现场评价(ROSE)的优势。只有TP和CS &TP组分别有29例(39.7%)和98例(19.2%)进行了后续切除。非诊断性病例的发生率在CS中较低;TP队列(12.7% vs. 26%)。虽然两组患者对意义不明的滤泡性病变的诊断率相似，但SFN分类仅用于CS &TP队列(1.5% vs. 0%)。虽然在许多TBSRTC类别中，RON和ROM在队列之间相似，但当分母包括所有非诊断病例时，仅TP队列中与非诊断标本相关的RON更高。结论:CS联合LBP可能会降低T-FNA标本的未诊断率和诊断所需的次数，尤其是ROSE。对常规涂片中突出的形态学特征进行评估可能有助于“疑似滤泡性肿瘤”的诊断分类。
期刊介绍：
With articles offering an excellent balance between clinical cytology and cytopathology, ''Acta Cytologica'' fosters the understanding of the pathogenetic mechanisms behind cytomorphology and thus facilitates the translation of frontline research into clinical practice. As the official journal of the International Academy of Cytology and affiliated to over 50 national cytology societies around the world, ''Acta Cytologica'' evaluates new and existing diagnostic applications of scientific advances as well as their clinical correlations. Original papers, review articles, meta-analyses, novel insights from clinical practice, and letters to the editor cover topics from diagnostic cytopathology, gynecologic and non-gynecologic cytopathology to fine needle aspiration, molecular techniques and their diagnostic applications. As the perfect reference for practical use, ''Acta Cytologica'' addresses a multidisciplinary audience practicing clinical cytopathology, cell biology, oncology, interventional radiology, otorhinolaryngology, gastroenterology, urology, pulmonology and preventive medicine.
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