Snead D R, Vryenhoef P, Pinder S E, Evans A, Wilson A R, Blamey R W, Elston C W, Ellis I O
Department of Pathology, City Hospital, Nottingham, UK.
Cytopathology. 1997 Aug;8(4):236-47. doi: 10.1046/j.1365-2303.1997.8682086.x.
In an attempt to improve the quality of the breast FNA specimens we instigated a continuing audit of this procedure in this hospital. All FNAs since 1990 have had the following recorded: mode of aspiration, e.g. freehand or image guided, patient presentation (screening or symptomatic), patient diagnostic category, cytological diagnosis and final histological diagnosis. Aspirator performance was assessed by means of the inadequate aspiration rate (IR) of FNAs performed on patients with a final diagnosis of cancer (FDC) and diagnostic category A patients (clinically or radiologically malignant lesions). An ongoing annual review of the performance of all the aspirators was undertaken, all of whom received individual feedback. Counselling and further training were offered where indicated by poor performance. Over the period 1990-1995 a total of 13537 FNAs were performed by 27 aspirators. The IR on category A and FDC cases over this period was 16.0% and 18.1%. The best performance achieved by an aspirator in a calendar year was an IR of 3.6% with no inadequate specimens in either FDC or category A lesions, and the best performance over the entire period was an average IR of 11.75% and 14.25% for FDC and category A groups, respectively. The overall IR on category A patients ranged from 15.9% to 23.8% and on FDC cases from 12.2% to 21.7%. There was a significant improvement in individual junior aspirator performance when their first year was compared with their last year on the unit. In some cases a deterioration in intra-aspirator performance was observed, from an IR of 6% to 33%. The overall IR rate of the unit remained stable for FDC patients, 15.5% in 1990 compared with 15.1% in 1995. This appeared to be largely due to a high proportion of the aspirations being performed by experienced personnel with consistent IRs. However, concealed within the overall rate there were some poor performers who benefited from counselling and/or further training. These results indicate an important role for audit in identifying poor aspirators who benefit from targeted training and advice, thereby improving the quality of FNA specimens, and ultimately patient care.
为提高乳腺细针穿刺抽吸活检（FNA）标本的质量，我们在本院启动了对该操作的持续审核。自1990年以来的所有FNA均记录了以下信息：抽吸方式，如徒手或影像引导；患者表现（筛查或有症状）；患者诊断类别；细胞学诊断和最终组织学诊断。通过对最终诊断为癌症（FDC）的患者以及诊断类别为A的患者（临床或放射学诊断为恶性病变）进行FNA时的抽吸不足率（IR）来评估抽吸器的性能。对所有抽吸器的性能进行年度持续审查，并向每个抽吸器提供个人反馈。对于表现不佳的抽吸器，根据情况提供咨询和进一步培训。1990年至1995年期间，27名抽吸器共进行了13537次FNA。在此期间，A类和FDC病例的IR分别为16.0%和18.1%。一名抽吸器在一个日历年中的最佳表现是IR为3.6%，FDC或A类病变均无抽吸不足的标本，在整个期间的最佳表现是FDC组和A类组的平均IR分别为11.75%和14.25%。A类患者的总体IR在15.9%至23.8%之间，FDC病例的IR在12.2%至21.7%之间。当将个别初级抽吸器在该科室的第一年与最后一年进行比较时，其表现有显著改善。在某些情况下，观察到抽吸器内部性能出现恶化，从IR为6%升至33%。该科室FDC患者的总体IR率保持稳定，1990年为15.5%，1995年为15.1%。这似乎主要是由于很大一部分抽吸操作是由经验丰富且IR一致的人员进行的。然而，在总体比率中存在一些表现不佳的抽吸器，它们从咨询和/或进一步培训中受益。这些结果表明审核在识别那些能从有针对性的培训和建议中受益的抽吸不佳者方面发挥着重要作用，从而提高FNA标本的质量，并最终改善患者护理。
