Zhu Weijian, Michael Claire W
Department of Pathology, University of Michigan Hospitals, Ann Arbor, MI 48109-0054, USA.
Diagn Cytopathol. 2007 Mar;35(3):183-6. doi: 10.1002/dc.20552.
Immediate adequacy assessment (IADA) during fine-needle aspiration (FNA) is not universal and the optimal number of passes has not been well determined. The aim of this study was to evaluate the nondiagnostic rates (NDR) with and without the IADA forthyroid aspirates. Subsequent cytological and surgical follow-up were reviewed for non-diagnostic cases. In addition, we evaluated the number of passes performed in each FNA to determine the optimal number. Retrospective analysis of NDR was performed on 883 thyroid FNA specimens retrieved through a Computer SNOMED Search from our files between January 2001 to December 2003. For FNAs with IADA, one Diff-Quick and one fixed smear for each pass were prepared, and the needle was rinsed in CytoLyt solution for a ThinPrep and/or a cell-block. FNAs without IADAwere received in CytoLyt solution, from which a ThinPrep and a cell-block were prepared for each case. Of the total 883 cases, 443 were performed with IADA, of which 417 cases were diagnostic. The remaining 440 cases were performed without IADA, of which 300 cases were diagnostic.NDR for IADA was 5.9% (26 cases-group-I)compared to 31.8% (140 cases-group-II)without IADA. In group-I, 5 cases were followed-up by repeat FNA, 10 cases by surgical resection, and 11 cases received no tissue follow-up. In group-II, 23 cases were followed-up by repeat FNA, 36 by surgical resection, and 82 cases received no tissue follow-up. Interestingly, follow-up in group-I did not reveal any missed malignancy, while that in group-II resulted in a malignant diagnosis in 13.8% (8 cases). We also found that the optimal number of passes with least NDR was 4-6 passes.NDR was 25% for < 3 passes, 11% for 4 passes, 5.2% for 5 passes, 1.4% for 6 passes, and 2.5% for 7 passesor more. IADA significantly reduces the NDR and increases the sample adequacy for diagnosis. Optimal number of passes is 4-6 passes, and additional passes did not improve the diagnostic rate. Our study also emphasizes the significance of repeat FNA or histological follow-up for nondiagnostic cases, especially for those without IADA.
细针穿刺活检（FNA）过程中的即时充分性评估（IADA）尚未普及，最佳穿刺次数也未明确确定。本研究旨在评估甲状腺穿刺活检有无IADA时的非诊断率（NDR）。对非诊断性病例进行了后续细胞学和手术随访。此外，我们评估了每次FNA的穿刺次数以确定最佳次数。对2001年1月至2003年12月间从我们的档案中通过计算机SNOMED检索获得的883份甲状腺FNA标本进行了NDR的回顾性分析。对于有IADA的FNA，每次穿刺制备一张Diff-Quick涂片和一张固定涂片，针在CytoLyt溶液中冲洗以制备ThinPrep涂片和/或细胞块。没有IADA的FNA标本置于CytoLyt溶液中，为每个病例制备一张ThinPrep涂片和一个细胞块。在总共883例病例中，443例进行了IADA，其中417例诊断明确。其余440例未进行IADA，其中300例诊断明确。有IADA时的NDR为5.9%（26例，第一组），无IADA时为31.8%（140例，第二组）。在第一组中，5例通过重复FNA进行随访，10例通过手术切除进行随访，11例未进行组织随访。在第二组中，23例通过重复FNA进行随访，36例通过手术切除进行随访，82例未进行组织随访。有趣的是，第一组的随访未发现任何漏诊的恶性肿瘤，而第二组的随访导致13.8%（8例）被诊断为恶性肿瘤。我们还发现，NDR最低的最佳穿刺次数为4 - 6次。穿刺次数<3次时NDR为25%，4次时为11%，5次时为5.2%，6次时为1.4%，7次及以上时为2.5%。IADA显著降低了NDR并提高了诊断样本的充分性。最佳穿刺次数为4 - 6次，额外穿刺并未提高诊断率。我们的研究还强调了对非诊断性病例进行重复FNA或组织学随访的重要性，特别是对于那些没有IADA的病例。
