title: Putting an eye on cytological specimens: an audit of the clinical impact of thyroid fine-needle aspiration in different health care settings.
abstract: There is published evidence showing less cost-benefit approaches in the evaluation of thyroid nodules. We performed an institutional audit of the cytologic diagnosis of thyroid fine-needle aspiration (FNA) in an attempt to perceive the clinical impact of this technique on the management of thyroid nodules and to compare it in two different types of health care: Primary Care Medicine and Endocrinology. We performed a retrospective analysis to the electronic records of patients referred from General Practitioners (GP) and Endocrinologists (E) for thyroid FNA between 2010 and 2012. Request forms for cytological reports where retrieved for analysis of clinical and cytological data. The database search retrieved 1655 patients (female gender: 88.2%; GP references: 51.8%). Preprocedure clinical information was available from 157 out of 2005 nodules (7.8%). Significant differences in cytological diagnosis were seen in "Nondiagnostic" (GP: 11.6%; E: 7.5%, χ(2)  = 0.002) and "Benign" categories (GP: 75%; E: 81.8%, χ(2)  < 0.001). The main potential cause of "Nondiagnostic" samples was nodules smaller than one centimeter (total: 14 cases; GP: 7; E: 7). Reasons to request FNA for these nodules were provided in 6 out of 27 cases (GP: 0/16; E: 6/11, P < 0.001). The rate of insufficient samples was inversely correlated with nodule size (τ = -0.242, P = 0.001). When evaluating thyroid nodules, clinicians should take into account the limitations of FNA, the international recommendations for better cost-benefit approaches and the importance of a well-informed cytopathologist for better cytological diagnostic results.
authors.affiliation: Serviço de Endocrinologia e Diabetes, Hospital Garcia de Orta, E.P.E., Almada-Setúbal, Portugal.
authors.forename: Bernardo Dias
authors.initials: BD
authors.lastname: Pereira
authors.forename: Renê
authors.initials: R
authors.lastname: Gerhard
authors.forename: Fernando
authors.initials: F
authors.lastname: Schmitt
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle / Q000379:methods; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013048:Specimen Handling / Q000191:economics / Q000379:methods; D013961:Thyroid Gland / Q000473:pathology* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000473:pathology*; D016606:Thyroid Nodule / Q000473:pathology*
keywords: clinical audit; fine-needle aspiration; thyroid nodule