Wang Jiaxin, Zhu Yanli, Song Yuntao, Xu Guohui, Yu Hao, Wang Tianxiao, Zhang Bin
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Gland Surg. 2020 Jun;9(3):711-720. doi: 10.21037/gs.2020.03.34.
Ultrasound-guided fine-needle aspiration (FNA) cytology is a crucial diagnostic technique used to assess thyroid nodules. In the past, ultrasound-guided FNA was performed mainly by radiologists. However, many surgeons are increasingly being trained for this procedure now. In this study, we aimed to compare the adequacy and efficiency of ultrasound-guided FNA performed by newly trained head and neck surgeons with experienced radiologists in a single institution. We also assessed the malignancy rates in nondiagnostic nodules and the differences between benign and malignant nodules.
This is a retrospective study. The data from patients who underwent ultrasound-guided FNA performed by surgeons or radiologists in two consecutive years were collected. Medical records, cytology results, and surgical pathology results were analyzed.
During the study period, a total of 2,405 ultrasound-guided FNAs were performed on 2,163 patients. The head and neck surgeons and radiologists performed 1,132 and 1,273 ultrasound-guided FNA procedures, respectively. The nondiagnostic rate was 14.49% for surgeons and 15.40% for radiologists (P=0.533). There were no differences in patient age, gender, nodule size, and other sonographic characteristics between the groups of patients who were treated by radiologists versus surgeons. The median waiting time from biopsy appointment to performing ultrasound-guided FNA was 0 days for head and neck surgeons, and 6 days for radiologists (P<0.001). Of the 40 patients who had a repeat FNA or surgery, 19 (47.50%) had a malignancy. Preoperative information about age, gender, operator, and characteristics of nodules did not predict the outcome of nodules with Bethesda category I.
The adequacy of ultrasound-guided FNAs performed by head and neck surgeons is similar to that of skilled radiologists, while surgeons are more efficient than radiologists. Nondiagnostic FNA reports should not be considered benign, and repeat FNA or selective surgical treatment is recommended.
超声引导下细针穿刺（FNA）细胞学检查是评估甲状腺结节的一项关键诊断技术。过去，超声引导下FNA主要由放射科医生进行。然而，现在许多外科医生也越来越多地接受这一操作的培训。在本研究中，我们旨在比较在单一机构中，新培训的头颈外科医生与经验丰富的放射科医生进行超声引导下FNA的充分性和效率。我们还评估了非诊断性结节的恶性率以及良性和恶性结节之间的差异。
这是一项回顾性研究。收集了连续两年接受外科医生或放射科医生进行超声引导下FNA的患者数据。分析病历、细胞学结果和手术病理结果。
在研究期间，共对2163例患者进行了2405次超声引导下FNA。头颈外科医生和放射科医生分别进行了1132次和1273次超声引导下FNA操作。外科医生的非诊断率为14.49%，放射科医生为15.40%（P = 0.533）。接受放射科医生治疗与接受外科医生治疗的患者组在患者年龄、性别、结节大小和其他超声特征方面没有差异。从活检预约到进行超声引导下FNA的中位等待时间，头颈外科医生为0天，放射科医生为6天（P < 0.001）。在40例进行重复FNA或手术的患者中，19例（47.50%）为恶性。年龄、性别、操作者和结节特征等术前信息无法预测贝塞斯达分类为I类结节的结果。
头颈外科医生进行超声引导下FNA的充分性与熟练的放射科医生相似，而外科医生比放射科医生更高效。非诊断性FNA报告不应被视为良性，建议进行重复FNA或选择性手术治疗。
