title: Ultrasound-guided fine-needle aspiration biopsy of the thyroid: role of on-site assessment and multiple cytologic preparations.
abstract: Several studies have shown that ultrasound guidance can serve as a valuable aid in improving the diagnostic yield of fine-needle aspiration (FNA) biopsy of thyroid nodules. In this study, we evaluated the combined impact of ultrasound-guidance, rapid on-site evaluation of FNA specimens, and different cytologic preparations (fresh and alcohol-fixed smears, Millipore filter) and staining methods (Diff-Quik and Papanicolaou stains) on the diagnostic yield of thyroid FNA. Ultrasound-guided FNA was performed on 282 patients (313 cases) between November 1997 and April 1999. The diagnostic categories included: benign (198 cases, 63.2%); indeterminate (42 cases, 13.4%); suspicious for follicular variant of papillary carcinoma (26 cases, 8.3%), malignant (32 cases, 10.1%); and nondiagnostic (15 cases, 5%). The nondiagnostic cases also included 6 cystic lesions without any solid component and 3 thyroid-bed aspirations. After excluding these, the nondiagnostic rate was only 2%. Histological follow-up was available in 77 (77/313) cases. The concordance rate between cytological and histological diagnosis was 100% in malignant, 67% in suspicious, and 56% in indeterminate cases. All cases with histologic follow-up were selected to evaluate the independent diagnostic efficacy of each aforementioned cytologic staining method. A definite diagnosis could be made solely on the basis of air-dried, Diff-Quik-stained preparations in 50 (65%), alcohol-fixed, Papanicolaou stained smears in 68 (88%), and Millipore filter preparations in 70 (91%) cases. We conclude that ultrasound-guided FNA combined with on-site evaluation and different cytologic preparations can significantly improve the diagnostic accuracy of thyroid FNA specimens.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA. baloch@mail.med.upenn.edu
authors.forename: Z W
authors.initials: ZW
authors.lastname: Baloch
authors.forename: D
authors.initials: D
authors.lastname: Tam
authors.forename: J
authors.initials: J
authors.lastname: Langer
authors.forename: S
authors.initials: S
authors.lastname: Mandel
authors.forename: V A
authors.initials: VA
authors.lastname: LiVolsi
authors.forename: P K
authors.initials: PK
authors.lastname: Gupta
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology; D001707:Biopsy, Needle; D018276:Carcinoma, Medullary / Q000000981:diagnostic imaging* / Q000473:pathology; D018277:Carcinoma, Mucoepidermoid / Q000000981:diagnostic imaging* / Q000473:pathology; D018265:Carcinoma, Papillary, Follicular / Q000000981:diagnostic imaging* / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D015203:Reproducibility of Results; D013194:Staining and Labeling; D013961:Thyroid Gland / Q000000981:diagnostic imaging* / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography