title: Surgeon-performed ultrasound-guided FNAC with on-site cytopathology improves adequacy and accuracy.
abstract: OBJECTIVE
  To demonstrate that surgeon-performed fine-needle aspiration cytology (FNAC) results in a high percent of satisfactory FNAC results; the number of passes to obtain a satisfactory cytological result with on-site cytopathological interpretation is reduced with ultrasound guidance (comparing FNAC with and without surgeon-performed ultrasound guidance); and immediate triage for indeterminate thyroid nodules can be performed in one setting for molecular testing, potentially improving selection for surgery.
  
  
  METHODS
  Retrospective cohort comparison.
  
  
  METHODS
  A cytopathologist is present for on-site staining adequacy evaluation and molecular testing triage for indeterminate cytology. Overall cytological adequacy and number of passes required to obtain cytological adequacy for 200 consecutive patients are compared with a historical series of 100 consecutive patients from the same surgeon and cytopathologists without ultrasound guidance.
  
  
  RESULTS
  The percent of patients with an adequate FNAC with ultrasound guidance was 100%. The mean number of passes with and without ultrasound guidance was 1.7 and 4.0 (P < 0.001). Indeterminate FNACs (9%) were triaged to molecular alteration testing and gene expression classifier testing.
  
  
  CONCLUSIONS
  Surgeon-performed ultrasound-guided FNAC with an experienced cytopathologist present resulted in a cytologically adequate result in 100% of cases. Significantly fewer passes for a satisfactory result were achieved with ultrasound guidance. Indeterminate FNAC can be triaged for molecular testing in one patient visit, was required in only 9% of carefully selected patients, and improved patient selection for surgery. The percent of patients who went on to surgery was 24 of 200 (12%). The percent of patients who had malignancy was 18 of 24 (75%).
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.|Department of Biological Sciences, University of Delaware, Newark, U.S.A.|Head and Neck Multidisciplinary Clinic, Helen F. Graham Cancer Center, Christiana Care, Newark, U.S.A.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Witt
authors.affiliation: Jefferson Integrated Bioscience Program, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.|Doctors Pathology Services, Dover, Delaware, U.S.A.
authors.forename: V Raman
authors.initials: VR
authors.lastname: Sukumar
authors.affiliation: Doctors Pathology Services, Dover, Delaware, U.S.A.
authors.forename: Fady
authors.initials: F
authors.lastname: Gerges
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D066231:Surgeons; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography
keywords: Thyroid; fine-needle aspiration cytology; gene expression testing; molecular alteration testing