Bellevicine C, Vigliar E, Malapelle U, Pisapia P, Conzo G, Biondi B, Vetrani A, Troncone G
Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy.
Department of Anesthesiologic, Surgical and Emergency Sciences, VII Division of General and Endocrine Surgery, Second University of Naples, Naples, Italy.
Cytopathology. 2016 Apr;27(2):115-21. doi: 10.1111/cyt.12243. Epub 2015 Mar 21.
In our Pathology Department, fine needle aspiration (FNA) of palpable thyroid nodules is performed by cytopathologists who ensure correct sample management and rapid on-site evaluation (ROSE). Conversely, ultrasound (US)-guided FNAs have traditionally been carried out by endocrinologists and radiologists in outside clinics, where the presence of a cytopathologist is not always feasible. To overcome this limitation, cytopathologists have started to perform US-guided FNAs themselves. This study retrospectively evaluates 1 year of this novel practice.
A total of 2225 US-guided FNAs were performed in our clinic by cytopathologists, whereas 1490 aspirates were taken by a group of non-cytopathologists. Among these, 756 FNAs were taken by a single experienced endocrinologist. The distribution of the Bethesda classification categories was evaluated in each of these groups.
FNAs performed by cytopathologists were more often diagnostic and better prepared than those taken by non-cytopathologists, including those taken by the experienced endocrinologist (P < 0.01). The latter operator yielded a higher rate of suspicious and malignant FNAs, reflecting a more appropriate clinical triage of worrisome nodules.
Although the endocrinologist's evaluation is crucial to select clinically relevant thyroid nodules, cytopathologists can reliably perform US guidance in addition to their traditional expertise in sampling, specimen preparation and ROSE.
在我们病理科，可触及甲状腺结节的细针穿刺抽吸术（FNA）由细胞病理学家进行，他们确保正确的样本管理和快速现场评估（ROSE）。相反，超声（US）引导下的FNA传统上由内分泌科医生和放射科医生在外部诊所进行，在这些诊所并不总是能够配备细胞病理学家。为克服这一限制，细胞病理学家已开始亲自进行超声引导下的FNA。本研究回顾性评估了这一创新做法的1年情况。
在我们诊所，细胞病理学家共进行了2225例超声引导下的FNA，而一组非细胞病理学家进行了1490例抽吸。其中，756例FNA由一位经验丰富的内分泌科医生进行。对这些组中每一组的贝塞斯达分类类别的分布情况进行了评估。
细胞病理学家进行的FNA比非细胞病理学家进行的FNA更常具有诊断价值且准备更充分，包括由经验丰富的内分泌科医生进行的FNA（P < 0.01）。后一位操作者产生的可疑和恶性FNA率更高，这反映了对可疑结节进行了更恰当的临床分类。
尽管内分泌科医生的评估对于选择具有临床意义的甲状腺结节至关重要，但细胞病理学家除了在采样、标本制备和ROSE方面的传统专业知识外，还能可靠地进行超声引导。
