Surgeon-performed ultrasound guided fine-needle aspirate biopsy with report of learning curve; a consecutive case-series study

Journal of Otolaryngology-Head & Neck Surgery

Kevin M. Higgins¹  Danny J. Enepekides¹  Robert J. De Santis²  Vinay T. Fernandes³ 

[1] Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto M4N 3 M5, ON, Canada;Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto M4N 3 M5, ON, Canada;Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada

关键词: Adequacy;    Learning curve;    Microcalcifications;    Cystic lesions;    Thyroid nodules;    Surgeon preformed;    Ultrasound-guided fine-needle aspiration biopsy;   

Others  :  1230374
DOI  :  10.1186/s40463-015-0099-x

 received in 2015-07-08, accepted in 2015-10-19,  发布年份 2015

【 摘 要 】

Background

Fine-needle aspiration biopsy has become the standard of care for the evaluation of thyroid nodules. More recently, the use of ultrasound guided fine-needle aspiration biopsy (UG-FNAB) has improved adequacy of sampling. Now there has been improved access to UG-FNAB as ultrasound technology has become more accessible. Here we review the adequacy rate and learning curve of a single surgeon starting at the adoption of UG-FNAB into surgical practice.

Methods

UG-FNABs performed at Sunnybrook Health Sciences Centre from 2010 to 2015 were reviewed retrospectively. Nodule characteristics were recorded along with cytopathology and final pathology reports. Chi-square analysis, followed by the reporting of odds ratios with confidence intervals, were used to assess the statistical significance and frequencies, respectively, of nodule characteristics amongst both diagnostic and non-diagnostic samples. A multiple regression analysis was conducted to determine if any nodule characteristic were predictive of adequacy of UG-FNABs. The learning curve was assessed by calculating the eventual adequacy rates across each year, and its statistical significance was measured using Fischer’s Exact Test.

Results

In total 423 biopsies were reviewed in 289 patients. The average nodule size was 23.05 mm. When examining if each patient eventually received a diagnostic UG-FNAB, regardless of the number attempts, adequacy was seen to increase from 70.8 % in 2010 to, 81.0 % in 2011, 90.3 % in 2012, 85.7 % in 2013, 89.7 % in 2014, and 94.3 % in 2015 (Fischer’s Exact Test, p = 0.049). Cystic (χ ²  = 19.70, p <0.001) nodules were found to yield higher rates of non-diagnostic samples, and their absence are predictive of obtaining an adequate biopsy as seen in a multiple regression analysis (p < 0.001) Adequacy of repeat biopsies following an initial non-diagnostic sample was 75.0 %.

Conclusions

Surgeons are capable of performing UG-FNAB with a learning curve noted to achieve standard adequacy rates. Cystic nodules are shown to yield more non-diagnostic samples in the surgeon’s office.

【 授权许可】

   
2015 Fernandes et al.

【 图 表 】

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【 参考文献 】

• [1]Bhatki AM, Brewer B, Robinson-Smith T, Nikiforov Y, Steward DL. Adequacy of surgeon-performed ultrasound-guided thyroid fine-needle aspiration biopsy. Otolaryngol Head Neck Surg. 2008; 139:27-31.
• [2]Bohacek L, Milas M, Mitchell J, Siperstein A, Berber E. Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules. Ann Surg Oncol. 2012; 19:45-51.
• [3]Carr S, Visvanathan V, Hossain T, Uppal S, Chengot P, Woodhead CJ. How good are we at fine needle aspiration cytology? J Laryngol Otol. 2010; 124:765-6.
• [4]Howlett DC, Harper B, Quante M, Berresford A, Morley M, Grant J et al.. Diagnostic adequacy and accuracy of fine needle aspiration cytology in neck lump assessment: results from a regional cancer network over a one year period. J Laryngol Otol. 2007; 121:571-9.
• [5]Al-azawi D, Mann GB, Judson RT, Miller JA. Endocrine surgeon-performed US guided thyroid FNAC is accurate and efficient. World J Surg. 2012; 36:1947-52.
• [6]Sidiropoulos N, Dumont LJ, Golding AC, Quinlisk FL, Gonzalez JL, Padmanabhan V. Quality improvement by standardization of procurement and processing of thyroid fine-needle aspirates in the absence of on-site cytological evaluation. Thyroid. 2009; 19:1049-52.
• [7]Baier ND, Hahn PF, Gervais DA, Samir A, Halpern EF, Mueller PR et al.. Fine-needle aspiration biopsy of thyroid nodules: experience in a cohort of 944 patients. AJR Am J Roentgenol. 2009; 193:1175-9.
• [8]Cai XJ, Valiyaparambath N, Nixon P, Waghorn A, Giles T, Helliwell T. Ultrasound-guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules. Cytopathology. 2006; 17:251-6.
• [9]Mittendorf EA, Tamarkin SW, McHenry CR. The results of ultrasound-guided fine-needle aspiration biopsy for evaluation of nodular thyroid disease. Surgery. 2002; 132:648-53.
• [10]Naïm C, Karam R, Eddé D. Ultrasound-guided fine-needle aspiration biopsy of the thyroid: methods to decrease the rate of unsatisfactory biopsies in the absence of an on-site pathologist. Can Assoc Radiol J. 2013; 64:220-5.
• [11]Isaac A, Jeffery CC, Seikaly H, Al-Marzouki H, Harris JR, Connell DA O. Predictors of non-diagnostic cytology in surgeon-performed ultrasound guided fine needle aspiration of thyroid nodules. J Otolaryngol Head Neck Surg. 2014; 43(1):48. BioMed Central Full Text
• [12]Schwartz J, How J, Lega I, Cote J, Gologan O, Rivera JA et al.. Ultrasound-guided fine-needle aspiration thyroid biopsies in the otolaryngology clinic. J Otolaryngol Head Neck Surg. 2010; 39(4):356-60.
• [13]Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. American Society for Clinical Pathology. 2009; 132:658-65.
• [14]Wright TP. Factors affecting the cost of airplanes. Journal of Aeronautical Science. 1936; 3:122-8.
• [15]Lee YJ, Kim DW, Jung SJ. Comparison of sample adequacy, pain-scale ratings, and complications associated with ultrasound-guided fine-needle aspiration of thyroid nodules between two radiologists with different levels of experience. Endocrine. 2013; 44:696-701.
• [16]Mahony GT, Mahony BS. Low nondiagnostic rate for fine-needle capillary sampling biopsy of thyroid nodules: a singular experience. J Ultrasound Med. 2013; 32:2155-61.
• [17]Lieu D. Cytopathologist-performed ultrasound-guided fine-needle aspiration and core-needle biopsy: a prospective study of 500 consecutive cases. Diagn Cytopathol. 2008; 36:317-24.
• [18]Hopper AN, Jamison MH, Lewis WG. Learning curves in surgical practice. Postgrad Med J. 2007; 83:777-9.
• [19]DelGaudio JM, Dillard DG, Albritton FD, Hudgins P, Wallace VC, Lewis MM. Computed tomography--guided needle biopsy of head and neck lesions. Arch Otolaryngol Head Neck Surg. 2000; 126:366-70.
• [20]Baloch ZW, Tam D, Langer J, Mandel S, LiVolsi VA, Gupta PK. Ultrasound-guided fine-needle aspiration biopsy of the thyroid: role of on-site assessment and multiple cytologic preparations. Diagn Cytopathol. 2000; 23:425-9.
• [21]Ghofrani M, Beckman D, Rimm DL. The value of onsite adequacy assessment of thyroid fine-needle aspirations is a function of operator experience. Cancer. 2006; 108:110-3.
• [22]Moberly AC, Vural E, Nahas B, Bergeson TR, Kokoska MS. Ultrasound-guided needle aspiration: impact of immediate cytologic review. Laryngoscope. 2010; 120:1979-84.
• [23]Olson MT, Tatsas AD, Ali SZ. Cytotechnologist-attended on-site adequacy evaluation of thyroid fine-needle aspiration: comparison with cytopathologists and correlation with the final interpretation. Am J Clin Pathol. 2012; 138:90-5.
• [24]Eedes CR, Wang HH. Cost-effectiveness of immediate specimen adequacy assessment of thyroid fine-needle aspirations. Am J Clin Pathol. 2004; 121:64-9.
• [25]Zanocco K, Pitelka-Zengou L, Dalal S, Elaraj D, Nayar R, Sturgeon C. Routine on-site evaluation of specimen adequacy during initial ultrasound-guided fine needle aspiration of thyroid nodules: a cost-effectiveness analysis. Ann Surg Oncol. 2013; 20:2462-7.