Structured Vs. Traditional Reporting of Fine Needle Aspirate of Thyroid Gland (FNAC): A Comparative Analysis

Program: Abstracts - Orals, Poster Previews, and Posters
Session: SAT 270-310-Thyroid Neoplasia (posters)
Saturday, April 2, 2016: 1:15 PM-3:15 PM
Exhibit/Poster Hall (BCEC)

Poster Board SAT 277
Iulia Andrada Ioana*1, Tadhg Gleeson2 and Obada Yousif2
1Mater Misericordiae Hospital, Dublin, Ireland, 2Wexford General Hospital, Wexford, Ireland

Large-scale studies have shown that the sensitivity of (FNAC) for identifying thyroid malignancy is 91.8%, and the specificity is 75.5 % (1). The introduction of the  Bethesda system for reporting thyroid cytology (BSRTC) has made it possible to standardise thyroid cytology reporting. (2)

Study: The aim of this study was to assess the diagnostic accuracy of (FNAC) of thyroid nodules and to evaluate the patterns of individual reporting variations between cytologists. We evaluated all (FNAC) in the period between 2005 and 2015. We identified two methods of (FNAC) reporting: Traditional and (BSRTC) based reporting. The ‘traditional’ reporting system was as follow: nondiagnostic, benign, suspicious or malignant. The (BSRTC) used the ‘thy’ classification. We used SPSS v15 statistical package for Analysis.

Results: We studied a total number of 156 patients. The groups were well matched for age (56.93±14.87 vs. 59.39 ±13.57, P=0.34) and nodule size (2.88±1.11cm vs. 3.32±1.36cm) for the traditional vs. (BSRTC) group respectively. Overall diagnostic adequacy was 95/156 (60.9%). In the ‘traditional group’, the diagnostic accuracy was 62/118 (52.54%) vs. 33/38 (86.84%) in the (BSRTC) group (P=0.001). We re-evaluated all non-diagnostic cytology reported with the ‘traditional method’ using (BSRTC) system. Cytology reports were assigned a group (Thy 1-5). Of the 56 non- diagnostic cytology, 29 reports (51.78%) originated from one cytopathologist. This represented 29/118 (24.6%) of the total inadequate cytology report in the traditional group. After applying the ’Thy‘ system: 17/56 (30.4%) were reassigned to thy2; 1/56 (1.8%) to thy3; 38/56 (67.8%) remained as thy1 (non-diagnostic); 10/18 (55.56%) of the reassigned reports belonged to one cytopathologist.

Conclusions: In the absence of a structured cytology reporting system, the process seems to be operator dependant. Reclassification using a structured approach improved the overall diagnostic accuracy to 113/156 (72.43%), (P= 0.015) with an improvement in the traditional group diagnostic yield to 80/118 (67.8%), ( P= 0.008). The use of the (BSRTC) reporting system improved our (FNAC) diagnostic yield significantly.

1. Ravetto C, Colombo L, Dottorini ME. Cancer 2000;90:357-63. Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients. 2. Baloch ZW, Cibas ES, Clark DP, Layfield LJ, Ljung B-M, Pitman MB, Abati A. Cytojournal 2008:5:6. The National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference: a summation.

Nothing to Disclose: IAI, TG, OY

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