甲状腺活检专家：一项旨在缩短等待时间和提高充分性率的质量倡议。
Thyroid Biopsy Specialists: A Quality Initiative to Reduce Wait Times and Improve Adequacy Rates.
机构信息
From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.).
出版信息
Radiology. 2015 Sep;276(3):894-9. doi: 10.1148/radiol.2015140620. Epub 2015 Apr 20.
PURPOSE
To develop and implement a program where selected sonographers would be trained to perform thyroid biopsies independently under the supervision of a radiologist, with the goal of improving efficiency and quality.
MATERIALS AND METHODS
Institutional research ethics board approval was obtained for this retrospective study, with waiver of informed consent. After approval from the relevant regulatory bodies, four sonographers successfully completed a training program and began to perform all thyroid biopsies (with informed consent) in a room adjacent to the main radiologist-run biopsy room, where the radiologist was available for backup as needed. In the preimplementation period (January 2010 to April 2011), 1321 nodules were biopsied, 29 of which included on-site cytopathology assessment. In the postimplementation period (August 2011 to July 2012), 1347 nodules were biopsied, 103 of which underwent on-site cytopathology assessment. Wait times and adequacy rates were calculated for both periods.
RESULTS
Patient wait times decreased from a mean of 80-90 days before implementation of the thyroid biopsy specialist program to 20-30 days afterward. The percentage of adequate samples improved from 74.6% (985 of 1321 nodules) to 78.6% (1059 of 1347 nodules), with a P value of .015 (74.1% [957 of 1292 nodules] to 77.5% [964 of 1244 nodules] when excluding nodules with on-site cytopathology assessment, P = .0497). The percentage of malignant samples showed no significant change in the two time periods, 5.1% (68 of 1321 nodules) before implementation of the program versus 5.4% (73 of 1347 nodules) after implementation, P = .823 (5.1% [66 of 1292 nodules] vs 5.3% [66 of 1244 nodules] in the respective time periods when excluding nodules with on-site cytopathology assessment, P = .888). No major procedural complications occurred.
CONCLUSION
Sonographers can be successfully trained to perform ultrasonography-guided thyroid biopsies safely under the supervision of a radiologist, which can improve wait times and adequacy rates.
目的
开发并实施一项计划，培训选定的超声医师在放射科医师的监督下独立进行甲状腺活检，以提高效率和质量。
材料和方法
本回顾性研究获得了机构研究伦理委员会的批准，并获得了豁免知情同意。在获得相关监管机构批准后，四位超声医师成功完成了培训计划，并开始在放射科医师主导的活检室隔壁的房间内进行所有甲状腺活检（获得知情同意），在需要时，放射科医师可随时提供支持。在实施前阶段（2010 年 1 月至 2011 年 4 月），对 1321 个结节进行了活检，其中 29 个结节进行了现场细胞学评估。在实施后阶段（2011 年 8 月至 2012 年 7 月），对 1347 个结节进行了活检，其中 103 个结节进行了现场细胞学评估。计算了两个时期的等待时间和充分性率。
结果
在实施甲状腺活检专家计划之前，患者的等待时间平均为 80-90 天，此后降至 20-30 天。充分样本的百分比从 74.6%（1321 个结节中的 985 个）提高到 78.6%（1347 个结节中的 1059 个），P 值为.015（957 个结节中的 74.1%[1292 个结节中的 985 个]与 964 个结节中的 77.5%[1244 个结节中的 1059 个]），当排除现场细胞学评估的结节时，P =.0497）。在这两个时期，恶性样本的百分比均无显著变化，实施该计划前为 5.1%（1321 个结节中的 68 个），实施后为 5.4%（1347 个结节中的 73 个），P =.823（在分别排除现场细胞学评估的结节时，1292 个结节中的 5.1%[66 个]与 1244 个结节中的 5.3%[66 个]，P =.888）。没有发生主要的程序并发症。
结论
可以成功培训超声医师在放射科医师的监督下安全地进行超声引导下的甲状腺活检，这可以提高等待时间和充分性率。
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