Houdek Devon, Cooke-Hubley Sandra, Puttagunta Lakshmi, Morrish Donald
Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Canada.
Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada.
Thyroid Res. 2021 Feb 10;14(1):2. doi: 10.1186/s13044-021-00093-2.
Thyroid nodules are common in clinical practice, and it is important to distinguish benign nodules, the vast majority, from malignant ones. Non-diagnostic (ND) samples have the potential to delay or mis-diagnose or lead to unnecessary surgeries, and it is important to examine what factors influence the ND rate. Prior literature has suggested that the impact of bedside cytology on ND rate is dependent on the initial adequacy rate, whereby higher ND rates benefit most from bedside cytology. We aim to compare the impact of bedside adequacy review between specialist groups who perform high volume thyroid biopsies with low initial ND rates.
We reviewed the cytopathology results of 1975 thyroid nodule FNAs performed between January 1, 2017 to December 31, 2017 in a multi-centre Canadian city, and the corresponding histopathology reports of 340 resected nodules. Descriptive variables were used to describe the data along with chi-squared testing and univariate logistic regression.
The FNA biopsies were performed by three different speciality groups, which differed by procedural volume: radiology performed the most at 1171, pathology performed 655 and surgery performed 103. We could not define the operator for 45 of the nodules. The ND rate was lowest in the speciality groups with highest procedural volume, 3.4 % in pathology and 8.3 % in radiology, compared to 37.9 % in surgery (p < 0.001). Completion of bedside cytology rapid onsite evaluation (ROSE) significantly reduced the ND rate from 16.7 to 4.2 % for all samples (p < 0.001). When ROSE was compared with non-ROSE within a high procedural group (radiology), it further reduced the ND rate from 12.5 to 5.1 % (p < 0.001). Of the 340 resected nodules, 10.7 % (18) were in the ND category, of which 28 % (5/18) of these were found to be malignant (4 papillary carcinoma and 1 lymphoma).
The results from this study demonstrate that thyroid FNAs performed with bedside ROSE can significantly reduce the ND rate compared with non-ROSE, even in experienced groups with low initial ND rates. It is therefore imperative that care providers managing patients with thyroid nodules ensure that thyroid FNAs are referred to specialized individuals/groups who do high volume, and ideally with the use of bedside ROSE, whether provided by a cytotechnologist or a pathologist.
甲状腺结节在临床实践中很常见，区分绝大多数良性结节与恶性结节非常重要。非诊断性（ND）样本有可能导致诊断延迟、误诊或引发不必要的手术，因此研究哪些因素会影响非诊断率很重要。既往文献表明，床边细胞学检查对非诊断率的影响取决于初始取材充足率，即非诊断率较高的情况从床边细胞学检查中获益最大。我们旨在比较在初始非诊断率较低的情况下，进行大量甲状腺活检的专科组之间床边取材评估的影响。
我们回顾了2017年1月1日至2017年12月31日在加拿大一个多中心城市进行的1975例甲状腺结节细针穿刺抽吸活检（FNA）的细胞病理学结果，以及340例切除结节的相应组织病理学报告。使用描述性变量以及卡方检验和单因素逻辑回归来描述数据。
FNA活检由三个不同的专科组进行，其操作量有所不同：放射科进行的最多，为1171例，病理科进行了655例，外科进行了103例。我们无法确定45个结节的操作者。操作量最高的专科组非诊断率最低，病理科为3.4%，放射科为8.3%，而外科为37.9%（p<0.001）。床边细胞学快速现场评估（ROSE）的完成显著降低了所有样本的非诊断率，从16.7%降至4.2%（p<0.001）。当在高操作量组（放射科）内将ROSE与非ROSE进行比较时，非诊断率进一步从12.5%降至5.1%（p<0.001）。在340例切除的结节中，10.7%（18个）属于非诊断类别，其中28%（5/18）被发现为恶性（4例乳头状癌和1例淋巴瘤）。
本研究结果表明，与非ROSE相比，采用床边ROSE进行甲状腺FNA可显著降低非诊断率，即使在初始非诊断率较低的经验丰富的组中也是如此。因此，管理甲状腺结节患者的医护人员必须确保将甲状腺FNA转诊给进行大量操作的专业人员/组，理想情况下使用床边ROSE，无论由细胞技术人员还是病理学家提供。
