Feletti F, Mellini L, Pironi F, Carnevale A, Parenti G C
Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy.
DAMeTLab, Unit of Anatomical Pathology, S. M. Delle Croci Hospital, Ravenna, Italy.
Insights Imaging. 2021 Aug 9;12(1):111. doi: 10.1186/s13244-021-01053-y.
This study aimed to conduct a diagnostic and cost-effective analysis of the cytopathology assistance in the ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) for characterising thyroid nodules.
We reviewed the reports relative to 9061 US-guided FNABs for the histologic definition of the nature of thyroid nodules: 45.4% completed with the cytopathologist assistance and 54.6% by the radiologist alone. We also performed the cost-effectiveness analysis (CEA) of the procedure with and without the cytopathologist assistance.
We found a significant positive correlation between the adoption/non-adoption of cytopathologist assistance and the number of indeterminate (TIR1) (Chi-square; z-score, Z = 10.22; critical value 5%, C = 1.96; p < 0.001). The cytopathologist's absence was correlated with the number of TIR 1 (Pearson correlation, product-moment correlation r = 0.059; critical value 5%, C = 0.008; p < 0.001). The total cost of the model's cytopathologist-assistance branch is 109.87€, while the total cost of the non-cytopathologist-assistance branch is 95.08€.
The cytopathologist assistance resulted in fewer nondiagnostic results, thus excluding the procedure's repetition but involved a higher expense, mainly due to the professional cost of the pathologist's participation. These data may provide decision-makers in healthcare with a practical evidence based on the opportunity to include the cytopathologist assistance in the thyroid nodule's FNAB depending on the available resources and the population's expectance.
本研究旨在对超声（US）引导下细针穿刺活检（FNAB）中细胞病理学辅助用于甲状腺结节特征性诊断进行诊断及成本效益分析。
我们回顾了9061例US引导下FNAB的报告，以确定甲状腺结节性质的组织学定义：45.4%在细胞病理学家协助下完成，54.6%仅由放射科医生完成。我们还对有无细胞病理学家协助的该操作进行了成本效益分析（CEA）。
我们发现细胞病理学家协助的采用与否与不确定（TIR1）数量之间存在显著正相关（卡方检验；z分数，Z = 10.22；临界值5%，C = 1.96；p < 0.001）。细胞病理学家不在场与TIR 1数量相关（Pearson相关性，积差相关r = 0.059；临界值5%，C = 0.008；p < 0.001）。模型中细胞病理学家协助分支的总成本为109.87欧元，而无细胞病理学家协助分支的总成本为95.08欧元。
细胞病理学家的协助导致非诊断性结果减少，从而避免了该操作的重复，但费用较高，主要是由于病理学家参与的专业成本。这些数据可为医疗保健决策者提供基于实际证据的参考，以便根据可用资源和人群期望决定是否在甲状腺结节的FNAB中纳入细胞病理学家的协助。
