title: Does routine consultation of thyroid fine-needle aspiration cytology change surgical management?
abstract: BACKGROUND
  Routine secondary cytologic review of thyroid gland fine-needle aspiration (FNA) specimens in patients referred from other institutions has been the recommended practice at some medical centers. We sought to determine the concordance rates between FNA interpretations at referring institutions and our center to determine if they alter surgical management.
  
  
  METHODS
  All thyroid gland FNAs referred to our center for cytopathologic opinion from June 2000 to August 2004 were reviewed. Patients in whom FNA biopsies were performed for thyroid cancer recurrences or core biopsies and patients in whom only a cytopathologic opinion was requested without a clinical consultation were excluded from the study. FNA results were divided into benign, indeterminate, suspicious, malignant, and nondiagnostic categories. FNA interpretations at our medical center and the referring institutions were compared with final histology results in patients who underwent operations.
  
  
  RESULTS
  One hundred forty-seven patients had secondary review of their thyroid gland FNA specimens. The overall concordance was 82%, with the highest concordance rate in the malignant category (95%) and the lowest in the suspicious category (62%, p<0.001). The sensitivity (94% versus 92%), specificity (76% versus 56%), and positive (93% versus 87%) and negative (79% versus 69%) predictive values were all higher on secondary review. Twenty-seven patients were found to have discordant FNA interpretations. As a result of the discordant FNA result, four patients had their surgical management decisions changed. Another four patients had appropriate oncologic thyroid resection as a result of the secondary review.
  
  
  CONCLUSIONS
  Our results suggest that routine secondary cytopathologic review of FNA specimens from referring institutions changes surgical management in some patients with thyroid neoplasms. We recommend this practice be widely used at other centers, especially for suspicious results.
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA 94143-1674, USA.
authors.forename: Yah Y
authors.initials: YY
authors.lastname: Tan
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.forename: Emily
authors.initials: E
authors.lastname: Reiff
authors.forename: Nadine R
authors.initials: NR
authors.lastname: Caron
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Ogilvie
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.forename: Orlo H
authors.initials: OH
authors.lastname: Clark
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Ljung
authors.forename: Theodore
authors.initials: T
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000473:pathology*; D016606:Thyroid Nodule / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy