THE LEARNING CURVE AND PERFORMANCE OF A NEWLY ESTABLISHED THYROID FINE-NEEDLE ASPIRATION CENTER

Overview

Journal Acta Endocrinol (Buchar)

Specialty Endocrinology

Date 2023 Jan 26

PMID 36699171

Authors

L G Deacu

D A Niculescu

D Terzea

C Cristea

D Ioachim

C Poiana

Affiliations

Soon will be listed here.

Abstract

Context: Thyroid fine-needle aspiration (FNA) cytology is the best tool for preoperative diagnosis of thyroid carcinoma; however, its learning curve is poorly described. Our aim was to assess the learning curve of a new thyroid FNA center involving unexperienced operator and pathologist.

Methods: We retrieved from our tertiary endocrinology center database all thyroid FNA procedures done by a single operator (endocrinologist with no experience in FNA) between 2018 and 2021. Cytology was assessed by two pathologists with limited or no experience in thyroid cytology. We also got the corresponding sex, age, nodule diameter, EU-TIRADS score, Bethesda category and final pathology report.

Results: There were 1872 FNA in 1618 patients. Proportion of Bethesda 1 nodules decreased significantly (p for trend=0.003) from 17% in the first 100 FNA procedures to 4% in the 401-500 group of procedures, and remained constant between 9% and 4% (p for trend=NS) for the rest of the study. Proportion of Bethesda 2 rose steady from 26% in the first 100 nodules to 80.1% in the last 241 nodules (p for trend<0.001). Indeterminate lesions (Bethesda 3 and 4) decreased significantly (p for trend=0.001) from 16% and 35% in the first 100 nodules to 2.5% and 5.8% in the last 241 lesions. Proportions of Bethesda 5+6 categories varied non-significantly over time. There were no time trends in the malignancy rate of surgically removed nodules.

Conclusions: At least 300 procedures are needed to reach the standard performance. A steadily state for the whole center is obtained after about 500 procedures.

References

Leung V, Kirpalani A, Mnatzakanian G, Colak E, Vlachou P . Effect of a Biopsy Center on Adequacy Rates of Thyroid Nodule Fine-Needle Aspiration. AJR Am J Roentgenol. 2017; 209(2):358-362. DOI: 10.2214/AJR.16.17157. View

Castro M, Gharib H . Thyroid fine-needle aspiration biopsy: progress, practice, and pitfalls. Endocr Pract. 2003; 9(2):128-36. DOI: 10.4158/EP.9.2.128. View

Son J, Rhee S, Woo J, Park W, Byun J, Kim Y . Insufficient experience in thyroid fine-needle aspiration leads to misdiagnosis of thyroid cancer. Endocrinol Metab (Seoul). 2014; 29(3):293-9. PMC: 4192815. DOI: 10.3803/EnM.2014.29.3.293. View

Donmez M, Aydin H, Kose E, Kahramangil B, Erten O, Gokceimam M . Standardization of thyroid fine needle aspiration procedure and outcomes within an endocrine surgery department. Gland Surg. 2021; 10(2):567-573. PMC: 7944063. DOI: 10.21037/gs-20-630. View

Hirokawa M, Suzuki A, Higuchi M, Hayashi T, Kuma S, Ito Y . The Japanese reporting system for thyroid aspiration cytology 2019 (JRSTAC2019). Gland Surg. 2020; 9(5):1653-1662. PMC: 7667058. DOI: 10.21037/gs-2019-catp-22. View

Nardi F, Basolo F, Crescenzi A, Fadda G, Frasoldati A, Orlandi F . Italian consensus for the classification and reporting of thyroid cytology. J Endocrinol Invest. 2014; 37(6):593-9. DOI: 10.1007/s40618-014-0062-0. View

Alshaikh S, Harb Z, Aljufairi E, Almahari S . Classification of thyroid fine-needle aspiration cytology into Bethesda categories: An institutional experience and review of the literature. Cytojournal. 2018; 15:4. PMC: 5841007. DOI: 10.4103/cytojournal.cytojournal_32_17. View

Fernandes V, De Santis R, Enepekides D, Higgins K . Surgeon-performed ultrasound guided fine-needle aspirate biopsy with report of learning curve; a consecutive case-series study. J Otolaryngol Head Neck Surg. 2015; 44:42. PMC: 4625451. DOI: 10.1186/s40463-015-0099-x. View

Tollin S, Mery G, Jelveh N, Fallon E, Mikhail M, BLUMENFELD W . The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with a multinodular goiter. Thyroid. 2000; 10(3):235-41. DOI: 10.1089/thy.2000.10.235. View

10.

Gerhard R, da Cunha Santos G . Inter- and intraobserver reproducibility of thyroid fine needle aspiration cytology: an analysis of discrepant cases. Cytopathology. 2007; 18(2):105-11. DOI: 10.1111/j.1365-2303.2006.00430.x. View

11.

Dhingra J . Ultrasound-Guided Fine-Needle Biopsy of First 1000 Consecutive Thyroid Nodules: Single-Surgeon Experience. OTO Open. 2020; 4(2):2473974X20929008. PMC: 7268147. DOI: 10.1177/2473974X20929008. View

12.

Gharib H, Papini E, Garber J, Duick D, Harrell R, Hegedus L . AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE. Endocr Pract. 2016; 22(5):622-39. DOI: 10.4158/EP161208.GL. View

13.

Wu H, Rose C, Elsheikh T . The Bethesda system for reporting thyroid cytopathology: An experience of 1,382 cases in a community practice setting with the implication for risk of neoplasm and risk of malignancy. Diagn Cytopathol. 2011; 40(5):399-403. DOI: 10.1002/dc.21754. View

14.

Cibas E, Ali S . The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2017; 27(11):1341-1346. DOI: 10.1089/thy.2017.0500. View

15.

Russ G, Bonnema S, Erdogan M, Durante C, Ngu R, Leenhardt L . European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J. 2017; 6(5):225-237. PMC: 5652895. DOI: 10.1159/000478927. View

16.

Cibas E, Ali S . The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol. 2009; 132(5):658-65. DOI: 10.1309/AJCPPHLWMI3JV4LA. View

17.

Bongiovanni M, Spitale A, Faquin W, Mazzucchelli L, Baloch Z . The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis. Acta Cytol. 2012; 56(4):333-9. DOI: 10.1159/000339959. View

18.

Mondal S, Sinha S, Basak B, Roy D, Sinha S . The Bethesda system for reporting thyroid fine needle aspirates: A cytologic study with histologic follow-up. J Cytol. 2013; 30(2):94-9. PMC: 3701345. DOI: 10.4103/0970-9371.112650. View

19.

Haugen B, Alexander E, Bible K, Doherty G, Mandel S, Nikiforov Y . 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2015; 26(1):1-133. PMC: 4739132. DOI: 10.1089/thy.2015.0020. View

20.

Pinchera A . Thyroid incidentalomas. Horm Res. 2008; 68 Suppl 5:199-201. DOI: 10.1159/000110625. View