title: Cost-effectiveness of fine-needle-aspiration cytology of thyroid nodules with intranodular vascular pattern using two different needle types.
abstract: OBJECTIVE
  To compare the cytological findings of hypoechoic thyroid nodules with intranodular vascular pattern (pattern II) obtained by two different needles (Neolus 25 gauge, Chemil, Wenzhou, China vs Yale Spinal 25 gauge, Becton Dickinson, Madrid, Spain) in euthyroid patients and to evaluate their cost-effectiveness.
  
  
  METHODS
  From January 2001 to December 2003, 480 euthyroid patients with a hypoechoic thyroid nodule pattern II were referred for US-FNAC. The nodules were alternatively evaluated by Neolus or by Yale Spinal with the stylet (YS+) or without the stylet (YS-), in order to evaluate if the cytological results could be due to the presence of the stylet or to the different length of the two needles. For each nodule two passes were performed and the material was obtained by capillary action. Material was smeared on slides, fixed, and stained by Papanicolaou techniques. Cytological specimens were evaluated in blind by the same experienced cytopathologist.
  
  
  RESULTS
  Inadequate cytological specimens because of blood contamination were present in 30 (18.7%) samples by Neolus needle and in 22 (13.8%) by YS- compared to only 5 (3.1%) by YS+. In 6 (20%) cases of the 30 repeated US-FNAC by Neolus and in 4 (18%) of the 22 US-FNAC by YS-, material remained inadequate for diagnosis because of blood contamination. All the five repeated samples obtained by YS+ became adequate for diagnosis and resulted benign nodules. Direct costs of US-FNAC procedure are currently 72.30 Euro including cytological examination. The cost of Neolus and Yale needles is 0.19 Euro and 3.0 Euro, respectively. The estimated total cost to obtain a cytological diagnosis by a Neolus needle (160 + 30 repeated US-FNAC) was 13809.2 Euro vs 12919.5 Euro by Yale Spinal needle (160 + 5 repeated US-FNAC).
  
  
  CONCLUSIONS
  This study demonstrates that the use of Yale Spinal needles greatly reduces inadequate cytological specimens, and therefore limits both direct and indirect costs.
authors.affiliation: Internal Medicine and Endocrinology, University of Brescia, Italy. cappi.tsh@libero.it
authors.forename: C
authors.initials: C
authors.lastname: Cappelli
authors.forename: A
authors.initials: A
authors.lastname: Tironi
authors.forename: C
authors.initials: C
authors.lastname: Mattanza
authors.forename: D
authors.initials: D
authors.lastname: Cumetti
authors.forename: B
authors.initials: B
authors.lastname: Agosti
authors.forename: E
authors.initials: E
authors.lastname: Gandossi
authors.forename: I
authors.initials: I
authors.lastname: Pirola
authors.forename: E
authors.initials: E
authors.lastname: De Martino
authors.forename: L
authors.initials: L
authors.lastname: Cherubini
authors.forename: L
authors.initials: L
authors.lastname: Micheletti
authors.forename: M
authors.initials: M
authors.lastname: Castellano
authors.forename: E Agabiti
authors.initials: EA
authors.lastname: Rosei
mesh_terms: D044963:Biopsy, Fine-Needle / Q000191:economics* / Q000295:instrumentation*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000191:economics*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000098:blood supply* / Q000175:diagnosis / Q000601:surgery*