Nagarajan Neeraja, Schneider Eric B, Ali Syed Z, Zeiger Martha A, Olson Matthew T
1 Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland.
Thyroid. 2015 Mar;25(3):308-13. doi: 10.1089/thy.2014.0394. Epub 2015 Jan 5.
Fine-needle aspiration (FNA) plays a pivotal role in the initial evaluation of patients with thyroid nodules. Traditionally, aspirated material is expelled directly onto the microscope slide to make a conventional smear (CS). Recently, liquid-based preparations (LBP) have gained in popularity. This study compares the accuracy of these two preparation techniques in diagnosing thyroid nodules.
A clinical database containing 5475 thyroid cytology consults from 2009 to 2013 was queried to identify 5169 CS and 306 LBP cases. Cytological diagnostic frequency rendered before and after second review were compared between LBP and CS. Correlation with the histology diagnosis was also calculated for each preparatory technique.
Age, sex, and nodule size were comparable between patients who had FNA processed by LBP and CS. More LBP cases than CS cases were inadequate (17% vs. 10%; p<0.001). LBP cases had fewer benign diagnoses (39% vs. 47%; p=0.003) and tended to have more malignant diagnoses (16% vs. 12%; p=0.09) when compared to CS. Indeterminate and suspicious categories were comparable between LBP and CS. Correlation with histology was also comparable between both techniques.
LBP was associated with a significantly higher proportion of inadequate and a lower proportion of benign diagnoses. Thus, universal adoption of LBP may introduce more inadequate samples. Future investigations should explore the lack of on-site evaluation with LBP as a potential source for the high inadequate rate.
细针穿刺抽吸术（FNA）在甲状腺结节患者的初步评估中起着关键作用。传统上，将抽吸物直接排到显微镜载玻片上制成传统涂片（CS）。最近，液基制片（LBP）越来越受欢迎。本研究比较了这两种制片技术在诊断甲状腺结节方面的准确性。
查询了一个包含2009年至2013年5475例甲状腺细胞学会诊的临床数据库，以确定5169例CS病例和306例LBP病例。比较了LBP和CS在二次复查前后做出的细胞学诊断频率。还计算了每种制片技术与组织学诊断的相关性。
接受LBP和CS处理的FNA患者在年龄、性别和结节大小方面具有可比性。LBP病例中不充分的病例比CS病例更多（17%对10%；p<0.001）。与CS相比，LBP病例的良性诊断较少（39%对47%；p=0.003），恶性诊断倾向于更多（16%对12%；p=0.09）。LBP和CS之间的不确定和可疑类别具有可比性。两种技术与组织学的相关性也具有可比性。
LBP与显著更高比例的不充分样本以及更低比例的良性诊断相关。因此，普遍采用LBP可能会引入更多不充分的样本。未来的研究应探讨缺乏LBP现场评估作为高不充分率潜在来源的问题。
