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Role of operator experience in ultrasound-guided fine-needle aspiration biopsy of the thyroid

Ruolo dell’esperienza dell’operatore nella citologia ecoguidata della tiroide

  • Head and Neck Radiology/Radiologia Del Capo E Del Collo
  • Published:
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Abstract

Purpose

Thyroid nodules are commonly encountered in clinical practice, and ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the gold standard in diagnosing the pathological nature of undetermined thyroid nodules. The aim of this study was to evaluate whether operator experience influences the diagnostic accuracy of US-guided FNAB.

Materials and methods

A total of 700 consecutive US-guided FNAB done by a single radiologist between 2000 and 2007 were retrospectively analysed. The same freehand technique and capillary-action technique with 22- or 25-gauge needles was used for all nodules, All specimens were prepared and fixed without the cytologist on site and were subsequently analysed by two expert cytologists. The procedures were chronologically divided into seven groups and classified as diagnostic or nondiagnostic.

Results

The rate of nondiagnostic procedures for each group was 32% in group 1, 13% in group 2, 17% in group 3, 11% in group 4, 10% in group 5, 5% in group 6 and 8% in group 7. No major complications were recorded.

Conclusions

The rate of nondiagnostic US-guided FNAB is heavily dependent on the operator’s experience. We estimated that at least 200 procedures need to be performed in order to achieve the levels of diagnostic accuracy reported in the literature. We therefore suggest specific training before operators routinely perform this procedure in clinical practice.

Riassunto

Obiettivo

I noduli tiroidei costituiscono un riscontro comune nella pratica clinica e la biopsia con ago sottile (FNAB)-ecoguidata rappresenta il gold standard diagnostico nella valutazione di pazienti con noduli indeterminati. L’obiettivo di questo studio è valutare quanto l’esperienza dell’operatore influisca sull’accuratezza diagnostica degli agoaspirati tiroidei ecoguidati.

Materiali e metodi

Sono state valutate retrospettivamente 700 FNAB-ecoguidate consecutive eseguite da un singolo radiologo dal 2000 al 2007, effettuate con tecnica a mano libera per capillarità con aghi da 22 G o 25 G, preparati ed allestiti senza citologo. Tutti i prelievi sono stati analizzati successivamente da due citologi esperti. Le procedure sono state stratificate cronologicamente in 7 gruppi e classificate come diagnostiche o non diagnostiche.

Risultati

Le procedure non diagnostiche di ogni singolo Gruppo sono: 32% nel Gruppo 1, 13% nel Gruppo 2, 17% nel Gruppo 3, 11% nel Gruppo 4, 10% nel Gruppo 5, 5% nel Gruppo 6 e 8% nel Gruppo 7. Non sono state riportate complicanze maggiori.

Conclusioni

La percentuale non-diagnostica di FNAB-ecoguidate tiroidee è fortemente dipendente dall’esperienza dell’operatore. Abbiamo stimato che siano necessarie almeno 200 procedure prima di raggiungere valori di accuratezza diagnostica riportati in letteratura. Suggeriamo pertanto uno specifico training dell’operatore prima di intraprendere questa procedura nella pratica clinica.

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References/Bibliografia

  1. Frates MC, Benson CB, Charboneau JW et al (2005) Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 237:794–800

    Article  PubMed  Google Scholar 

  2. Brander A, Viikinkoski P, Nickels J, Kivisaari L (1991) Thyroid gland: US screening in a random adult population. Radiology 181:683–687

    CAS  PubMed  Google Scholar 

  3. Harach HR, Franssila KO, Wasenius VM (1985) Occult papillary carcinoma of the thyroid: a “normal” finding in Finland - a systematic autopsy study. Cancer 56:531–538

    Article  CAS  PubMed  Google Scholar 

  4. Tan GH, Gharib H (1997) Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 126:226–231

    CAS  PubMed  Google Scholar 

  5. AACE/AME Task Force on Thyroid Nodules (2006) American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 12:63–102

    Google Scholar 

  6. Cooper DS, Doherty GM, Haugen BR et al (2006) The American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:109–142

    Article  PubMed  Google Scholar 

  7. Braga M, Cavalcanti TC, Collaço LM, Graf H (2001) Efficacy of ultrasound - guided fine-needle aspiration biopsy in the diagnosis of complex thyroid nodules. J Clin Endocrinol Metab 86:4089–4091

    Article  CAS  PubMed  Google Scholar 

  8. Cappelli C, Pirola I, Castellano M et al (2007). Fine needle cytology of complex thyroid nodules. Eur J Endocrinol 157:529–532

    Article  CAS  PubMed  Google Scholar 

  9. Danese D, Sciacchitano S, Farsetti A et al (1998) Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 8:15–21

    Article  CAS  PubMed  Google Scholar 

  10. Hatada T, Okada K, Ishii H et al (1998) Evaluation of ultrasound-guided fineneedle aspiration biopsy for thyroid nodules. Am J Surg 175:133–136

    Article  CAS  PubMed  Google Scholar 

  11. Ghofrani M, Beckman D, Rimm DL (2006) The value of onsite adequacy assessment of thyroid fine-needle aspirations is a function of operator experience. Cancer 108:110–113

    Article  PubMed  Google Scholar 

  12. Stacul F, Bertolotto M, De Gobbis F et al (2007) US, colour-Doppler US and fine-needle aspiration biopsy in the diagnosis of thyroid nodules. Radiol Med 112:751–762

    Article  CAS  PubMed  Google Scholar 

  13. Ljung BM, Drejet A, Chiampi N et al (2001) Diagnostic accuracy of fineneedle aspiration biopsy is determined by physician training in sampling technique. Cancer 93:263–268

    Article  CAS  PubMed  Google Scholar 

  14. Bhatki AM, Brewer B, Robinson-Smith T et al (2008) Adequacy of surgeon-performed ultrasound-guided thyroid fine-needle aspiration biopsy. Otolaryngol Head Neck Surg 139:27–31

    Article  PubMed  Google Scholar 

  15. Carmeci C, Jeffrey RB, McDougall IR et al (1998) Ultrasound-guided fine-needle aspiration biopsy of thyroid masses. Thyroid 8:283–289

    Article  CAS  PubMed  Google Scholar 

  16. Marqusee E, Benson CB, Frates MC et al (2000) Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med 133:696–700

    CAS  PubMed  Google Scholar 

  17. Stacul F, Bertolotto M, Zappetti R et al (2007) The radiologist and the cytologist in diagnosing thyroid nodules: results of cooperation. Radiol Med 112:597–602

    Article  CAS  PubMed  Google Scholar 

  18. Tublin ME, Martin JA, Rollin LJ et al (2007) Ultrasound-guided fine-needle aspiration versus fine-needle capillary sampling biopsy of thyroid nodules: does technique matter? J Ultrasound Med 26:1697–1701

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Divisione di Radiologia, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milano, Italy

    E. De Fiori, C. Rampinelli, L. Bonello & M. Bellomi

  2. Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, 20100, Milano, Italy

    F. Turco & M. Bellomi

Authors
  1. E. De Fiori
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  2. C. Rampinelli
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  3. F. Turco
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  4. L. Bonello
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  5. M. Bellomi
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Correspondence to C. Rampinelli.

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De Fiori, E., Rampinelli, C., Turco, F. et al. Role of operator experience in ultrasound-guided fine-needle aspiration biopsy of the thyroid. Radiol med 115, 612–618 (2010). https://doi.org/10.1007/s11547-010-0528-x

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  • DOI: https://doi.org/10.1007/s11547-010-0528-x

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