Nacchio Mariantonia, Palladino Raffaele, Vigliar Elena, Pisapia Pasquale, Salatiello Maria, Malapelle Umberto, Porcelli Tommaso, Luongo Cristina, Fonderico Francesco, Masone Stefania, Salvatore Domenico, Troncone Giancarlo, Bellevicine Claudio
Department of Public Health, University of Naples Federico II, Naples, Italy.
Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Cancer Cytopathol. 2023 Dec;131(12):772-780. doi: 10.1002/cncy.22756. Epub 2023 Aug 28.
The diagnostic accuracy of thyroid fine-needle aspiration (FNA) can be highly influenced by the technical skills of the operator performing the procedure and by interobserver variability in microscopic interpretation. This is particularly true for the indeterminate categories. Recently, molecular testing has been proposed as an ancillary tool for monitoring the performance of different thyroid cytopathology practices. The objective of this multicenter study was to evaluate the quality of different local cytopathology practices by assessing the impact of interventional cytopathologists on FNA adequacy for molecular testing and the variations in mutation rates across different health care centers operating in the Campania region.
The study included 4651 thyroid FNA samples diagnosed in different Southern Italian clinical laboratories belonging to the TIRNET (the Tiroide Network). FNA samples were collected by different proceduralists and were classified by local cytopathologists according to The Bethesda System for Reporting Thyroid Cytopathology. FNAs classified as atypia of undetermined significance, follicular neoplasm, suspicious for malignancy, and malignant were centralized for a real-time polymerase chain reaction-based, seven-gene test at the authors' institution.
Centers that employed interventional cytopathologists obtained fewer unsatisfactory FNA samples for molecular testing (11.3%) than centers that employed noncytopathologists (16.7%; p < .05). Furthermore, a significant variation in the mutation rate was observed in FNAs diagnosed by different local cytopathologists; indeterminate categories had the highest percentage of mutation rate variability among centers.
Interventional cytopathologists obtained higher yields of diagnostic material for molecular testing. Finally, the current results suggest that the variability in mutation rates among different centers may highlight the low reproducibility of microscopic criteria among cytopathologists, particularly for indeterminate cases.
甲状腺细针穿刺活检（FNA）的诊断准确性会受到操作该程序的操作人员技术水平以及显微镜检查中观察者间差异的极大影响。对于不确定类别尤其如此。最近，分子检测已被提议作为监测不同甲状腺细胞病理学实践表现的辅助工具。这项多中心研究的目的是通过评估介入细胞病理学家对用于分子检测的FNA充分性的影响以及坎帕尼亚地区不同医疗中心之间突变率的差异，来评估不同地方细胞病理学实践的质量。
该研究纳入了在属于TIRNET（甲状腺网络）的不同意大利南部临床实验室诊断的4651份甲状腺FNA样本。FNA样本由不同的操作人员采集，并由当地细胞病理学家根据《甲状腺细胞病理学报告贝塞斯达系统》进行分类。分类为意义不明确的非典型病变、滤泡性肿瘤、可疑恶性肿瘤和恶性肿瘤的FNA样本被集中到作者所在机构进行基于实时聚合酶链反应的七基因检测。
与采用非细胞病理学家的中心（16.7%）相比，采用介入细胞病理学家的中心获得的用于分子检测的FNA样本不满意率更低（11.3%；p <.05）。此外，在不同当地细胞病理学家诊断的FNA样本中观察到突变率存在显著差异；不确定类别在各中心之间的突变率变异性百分比最高。
介入细胞病理学家获得了更高产量的用于分子检测的诊断材料。最后，当前结果表明不同中心之间突变率的差异可能凸显了细胞病理学家之间微观标准的低再现性，尤其是对于不确定病例。
