title: Thin core needle biopsy crush preparations in conjunction with fine-needle aspiration for the evaluation of thyroid nodules: a complementary approach.
abstract: BACKGROUND
  Fine-needle aspiration (FNA) is widely accepted as the initial test to evaluate thyroid nodules; however, inadequate and suboptimal specimens have been 1 of its limitations. Unsatisfactory rates of 4.1% to 43% have been reported, but suboptimal specimens with adequate epithelial cells and other limiting factors, such as clotting, often are not addressed. The authors' institution has a low unsatisfactory rate, especially for thyroid biopsies performed under ultrasound in the Interventional Radiology (IR) Department. In addition to on-site evaluation for all cases, they concomitantly use thin, 22/20-gauge core needle biopsy (CB) crush preparations (CP) for unsatisfactory/suboptimal FNAs. The CB usually is done after 2 FNA passes and, in most cases, is exhausted by making an air-dried CP, which is evaluated on site for adequacy; any residual tissue is processed for tissue sections. Experience is required to interpret CP on air-dried smears. In this report, the authors describe a complementary approach to thyroid biopsy that has worked well.
  
  
  METHODS
  All thyroid FNA and CB/CP that were performed in the IR Department during the year 2005 were reviewed. Follow-up histology and records of all procedural complications were retrieved.
  
  
  RESULTS
  Seven hundred thirteen thyroid biopsies qualified, 225 biopsies (31%) had FNA with CB/CP (85% had only CP for evaluation), and 488 biopsies (69%) had only FNA. The final unsatisfactory rate in IR for FNA was 8.7%; this was reduced to 3.4% with the use of CB/CP. The addition of CB also helped to obtain a more definitive diagnosis in suboptimal FNA specimens. Cytologic-histologic correlation was comparable for FNA only cases and FNA/CB cases. There were no significant procedural complications in CB cases.
  
  
  CONCLUSIONS
  FNA in conjunction with a thin CB/CP performed during the same procedure is a safe technique that can reduce the rate of unsatisfactory and suboptimal thyroid biopsy.
authors.affiliation: Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Songlin
authors.initials: S
authors.lastname: Zhang
authors.forename: Marina
authors.initials: M
authors.lastname: Ivanovic
authors.forename: Albert A
authors.initials: AA
authors.lastname: Nemcek
authors.forename: Denise V S
authors.initials: DV
authors.lastname: Defrias
authors.forename: Erin
authors.initials: E
authors.lastname: Lucas
authors.forename: Ritu
authors.initials: R
authors.lastname: Nayar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013961:Thyroid Gland / Q000473:pathology*; D016606:Thyroid Nodule / Q000473:pathology*