Houlton Jeffrey J, Sun Gordon H, Fernandez Nella, Zhai Qihui Jim, Lucas Fred, Steward David L
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Academic Health Center, 231 Albert Sabin Way, Cincinnati, OH 45267-0528, USA.
Arch Otolaryngol Head Neck Surg. 2011 Nov;137(11):1136-9. doi: 10.1001/archoto.2011.185.
To evaluate the effect of case volume on the diagnostic yield and interpretation of thyroid fine-needle aspiration (FNA).
Retrospective case series.
An academic tertiary referral center and 2 community hospital centers.
Data were retrospectively reviewed for all consecutive patients undergoing thyroid FNA at these institutions during the 2009 calendar year.
Differences in diagnostic distribution and yield among pathologists and clinicians of differing case volume.
A total of 790 patients underwent thyroid FNA, with the results interpreted as benign (479 [60%]), atypical (166 [22%]), malignant (9 [1%]), or nondiagnostic (136 [17%]). The FNAs were performed by 134 physicians and interpreted by 16 pathologists with varying case volumes. Low-volume pathologists (<50 FNAs interpreted) were more likely to report atypical FNAs (32% vs 13%; P < .001) and less likely to call FNAs benign (50% vs 70%; P < .001) compared with high-volume pathologists (≥50 FNAs interpreted), and compared with expected normative data (benign, P < .001; atypical, P < .001). Atypical FNA findings reported by low-volume pathologist were more likely to yield benign permanent results than those read by high-volume pathologists (64% vs 42%; P < .02). Low-volume clinicians (<20 FNAs performed) were not more likely to perform nondiagnostic FNAs compared with high-volume clinicians (≥20 FNAs performed) (16% vs 15%; P = .47).
Case volume significantly influences the pathologic interpretation of thyroid FNA, as low-volume pathologists report more atypical and fewer benign FNA results. Case volume did not have a significant impact on diagnostic yield, because thyroid FNAs performed by low-volume clinicians did not result in more frequent nondiagnostic results compared with those performed by high-volume clinicians.
评估病例数量对甲状腺细针穿刺活检（FNA）诊断率及结果判读的影响。
回顾性病例系列研究。
一家学术性三级转诊中心和两家社区医院中心。
对2009年在这些机构接受甲状腺FNA的所有连续患者的数据进行回顾性分析。
不同病例数量的病理学家和临床医生在诊断分布及诊断率上的差异。
共有790例患者接受了甲状腺FNA，结果判读为良性（479例[60%]）、非典型性（166例[22%]）、恶性（9例[1%]）或无法诊断（136例[17%]）。FNA由134名医生操作，由16名病例数量不同的病理学家进行判读。与高病例数量的病理学家（≥50例FNA判读）相比，低病例数量的病理学家（<50例FNA判读）更有可能报告非典型性FNA结果（32%对13%；P<0.001），而将FNA判读为良性的可能性更小（50%对70%；P<0.001），且与预期的标准数据相比也存在差异（良性，P<0.001；非典型性，P<0.001）。低病例数量的病理学家报告的非典型性FNA结果产生良性最终结果的可能性高于高病例数量的病理学家（64%对42%；P<0.02）。与高病例数量的临床医生（≥20例FNA操作）相比，低病例数量的临床医生（<20例FNA操作）进行无法诊断的FNA的可能性并未增加（分别为16%和15%；P=0.47）。
病例数量显著影响甲状腺FNA的病理判读，因为低病例数量的病理学家报告的非典型性FNA结果更多，良性FNA结果更少。病例数量对诊断率没有显著影响，因为与高病例数量的临床医生相比，低病例数量的临床医生进行的甲状腺FNA并不会导致更多无法诊断的结果。
