title: Cytotechnologist performance for screening microfollicular atypia in indeterminate thyroid fine-needle aspirates.
abstract: BACKGROUND
  We previously identified a high level of accuracy among our cytotechnologists (CTs) for identifying nuclear atypia in thyroid fine-needle aspiration (FNA) specimens. Herewith, we present our CT performance at screening for microfollicular atypia.
  
  
  METHODS
  8,814 thyroid FNA specimens were identified in our archives, all screened by 1 of 11 CTs and signed out by a cytopathologist. A subsample of cases was categorized either as atypia of uncertain significance (AUS) with microfollicular proliferation (AUS-F) or suspicious for a follicular neoplasm (SFN).
  
  
  RESULTS
  The agreement rate was low between CTs and cytopathologists for SFN and AUS-F. Only 55.8% of SFN screening diagnoses were upheld; 27.9% were downgraded to AUS, 10.4% were downgraded to benign, and 5% were upgraded. Of AUS-F screening diagnoses, 35.5% were upheld, 33.7% were downgraded to benign, and 20.2% were upgraded to SFN. Among all cases, two-step discrepancies were uncommon.
  
  
  CONCLUSIONS
  Most disagreements were one-category discrepancies between AUS-F and SFN. The evaluation of microfollicular atypia is challenging given that certain follicular lesions cannot be definitively diagnosed on cytology, a high level of subjectivity is involved in the interpretation of such lesions, and the presence of nuclear or Hurthle cell atypia may complicate the diagnosis.
authors.affiliation: Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Md., USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: VandenBussche
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Olson
authors.forename: Christina
authors.initials: C
authors.lastname: Adams
authors.forename: Syed Z
authors.initials: SZ
authors.lastname: Ali
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D003581:Cytodiagnosis; D003937:Diagnosis, Differential; D005260:Female; D050031:Hashimoto Disease / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011361:Professional Competence / Q000706:statistics & numerical data*; D013961:Thyroid Gland / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000473:pathology