VandenBussche Christopher J, Adams Christina, Ali Syed Z, Olson Matthew T
Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Md., USA.
Acta Cytol. 2014;58(3):239-47. doi: 10.1159/000362681. Epub 2014 Jun 13.
The thyroid gland is arguably the fastest growing anatomic site for fine needle aspiration (FNA). With the increase of thyroid cases, a reevaluation of cytotechnologist screening quality metrics in terms of thyroid FNA is called for. We present our institutional cytotechnologist performance at screening for nuclear atypia by applying established quality metrics.
Information on 8,814 consecutive thyroid cytopathology cases over a 10-year period was retrieved from computerized records. A subsample of cases categorized either as atypia of uncertain significance with nuclear atypia or suspicious for malignancy with features suspicious for papillary thyroid carcinoma. The cytotechnologist and cytopathologist diagnoses were compared using step discrepancies and Δ-ratios.
Overall discrepancy between the cytotechnologist and cytopathologist diagnoses existed in <10% of all thyroid cases. One-category discrepancies were the most common (7.8%), while two-category discrepancies were rare (0.5%). The one-category discrepancy rate correlated with cytotechnologist experience. One-category under calls were twice as common as over calls (5.3 vs. 2.5%, p < 0.0001).
We identified a high level of quality in the screening for nuclear atypia in thyroid FNA. The one-category discrepancy rate is suited to tracking individual cytotechnologist performance, identifies outliers and appears to correlate with cytotechnologist experience.
甲状腺可能是细针穿刺活检（FNA）中增长最快的解剖部位。随着甲状腺病例数量的增加，需要重新评估细胞技术人员在甲状腺FNA筛查中的质量指标。我们通过应用既定的质量指标，展示了我们机构细胞技术人员在筛查核异型性方面的表现。
从计算机记录中检索了10年间连续8814例甲状腺细胞病理学病例的信息。对分类为具有核异型性的意义不明确的异型性或具有可疑甲状腺乳头状癌特征的可疑恶性病例进行了子样本分析。使用分级差异和Δ比率比较细胞技术人员和细胞病理学家的诊断。
细胞技术人员和细胞病理学家诊断之间的总体差异存在于所有甲状腺病例的不到10%中。一类差异最为常见（7.8%），而二类差异很少见（0.5%）。一类差异率与细胞技术人员的经验相关。一类漏诊比误诊常见两倍（5.3%对2.5%，p<0.0001）。
我们发现甲状腺FNA核异型性筛查的质量水平较高。一类差异率适合跟踪个体细胞技术人员的表现，识别异常值，并且似乎与细胞技术人员的经验相关。
