Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13214, USA.
Endocr Pract. 2013 Jan-Feb;19(1):14-8. doi: 10.4158/EP11374.OR.
In this study we discuss the diagnostic accuracy and unsatisfactory rate of onsite evaluation of ultrasound-guided fine needle aspiration (USGFNA) of thyroid nodules using telecytopathology and compare it to that of a control group without telecytopathology.
This was a retrospective analysis of USGFNA of thyroid nodules over a 9-month period with and without telecytopathology. There was no randomization for selection of the groups with and without telepathologist. A single provider performed all the procedures. Real-time images of Diff Quik-stained cytology smears were obtained with an Olympus Digital camera attached to an Olympus CX41 microscope and transmitted via the Internet by a cytotechnologist to a pathologist, who communicated the preliminary diagnosis and sample adequacy. The unsatisfactory specimen rate was compared between a group whose images were transmitted (n = 45) and another group without onsite adequacy assessment (nontransmitted) (n = 47).
A total of 92 nodules in 67 patients were aspirated with ultrasound guidance. The unsatisfactory sample rate in the transmitted group was 13% (6 out of 45) and that of the non-transmitted group was 23% (11 out of 47). In the transmitted group, the cytology specimens of 3 patients that were initially deemed inadequate by the pathologist were considered adequate after 2 additional passes. In the transmitted group, preliminary diagnosis concurred with the final diagnosis in 96% of cases. Four passes were made in the non-transmitted group, versus 2 passes in the transmitted group.
Immediate assessment of USGFNA via telecytopathology assures adequacy of the cytology sample and may reduce number of passes per nodule. Preliminary onsite telecytopathology diagnosis was highly accurate when compared to final diagnosis.
本研究探讨了使用远程细胞学诊断对超声引导下甲状腺细针抽吸术（USGFNA）的现场评估的诊断准确性和不满意率，并将其与无远程细胞学诊断的对照组进行比较。
这是一项为期 9 个月的超声引导下甲状腺结节 USGFNA 回顾性分析，其中包括有远程细胞学诊断和无远程细胞学诊断。选择有和无远程病理学家的组没有进行随机分组。所有操作均由一位提供者完成。使用 Olympus Digital 相机实时拍摄 Diff Quik 染色细胞学涂片的图像，并通过 Cytotechnologist 通过互联网传输给病理学家，病理学家沟通初步诊断和样本充足性。比较了传输图像组（n=45）和未进行现场评估组（未传输）（n=47）的不满意标本率。
共对 67 例患者的 92 个结节进行了超声引导抽吸。传输组的不满意标本率为 13%（45 例中的 6 例），未传输组的不满意标本率为 23%（47 例中的 11 例）。在传输组中，最初被病理学家认为不充分的 3 例细胞学标本在进行 2 次额外抽吸后被认为是充分的。在传输组中，初步诊断与最终诊断的符合率为 96%。在未传输组中进行了 4 次抽吸，而在传输组中进行了 2 次抽吸。
通过远程细胞学即时评估可确保细胞学样本的充分性，并可能减少每个结节的抽吸次数。与最终诊断相比，初步现场远程细胞学诊断具有很高的准确性。
