Abstract
PurposeTo investigate the diagnostic accuracy of a different sample preparation protocol for fine needle aspiration cytology (FNAC) of thyroid nodules established during the COVID‐19 pandemic.MethodsFrom April 2020, conventional smears during FNAC were ceased according to World Health Organization recommendations due to the increased infection risk for operators, and a new protocol using only liquid‐based cytology (LBC) was adopted. FNACs performed between April and July 2020 (COVID‐19 group) were retrospectively compared with those from December 2019 through March 2020 (Pre‐COVID‐19 group). The distribution of diagnoses based on SIAPEC‐IAP categories and the concordance between cytological and histological results were compared using the chi‐squared test.ResultsCategories based on FNAC for 90 and 82 thyroid nodules in the Pre‐COVID‐19 and COVID‐19 groups showed no significant difference in distribution (P = .081), with the following respective cases (and percentages): TIR1, 7 (8%) and 8 (10%); TIR1C, 0 (0%) and 6 (7%); TIR2, 59 (66%) and55 (67%); TIR3A, 8 (9%) and 5 (6%); TIR3B, 1 (1%) and 2 (3%); TIR4, 5 (6%) and 1 (1%); and TIR5, 10 (12%) and 5 (7%). Among patients with potentially malignant lesions, surgery was performed for 12/16 (75%) nodules in the Pre‐COVID‐19 and 7/8 (88%) nodules in the COVID‐19 groups, with no significant differences between cytological and histological diagnoses (P = .931).ConclusionThe new LBC‐only protocol provided similar diagnostic accuracy in comparison with conventional smears, and can be effectively applied during a viral pandemic improving operator safety.
Highlights
Thyroid nodules are very common in the general population, especially in women,[1] and thyroid cancer is the most common neoplasm of the endocrine system, accounting for about 90% of cases.Most thyroid lesions are benign and the malignant ones account for less than 10%,2 being usually well-differentiated neoplasms with a slow growth and excellent outcomes
Liquid-based methods for cytology (LBC) have been reported to provide good diagnostic accuracy and are becoming routinely used, either alone or in combination with standard cytological preparation, especially to standardise the preanalytical procedures that are needed to perform immunocytochemistry (ICC) or molecular tests.8-11 Even if there is still some debate regarding the routine application of LBC in thyroid fine needle aspiration cytology (FNAC), it should be noted that this method carries the not negligible advantage of reducing the risk of aerosol diffusion of potentially infected material, which could be of particular value during a pandemic
The aim of this work is to report the diagnostic accuracy of this new sample preparation protocol for FNAC of thyroid nodules established during the COVID-19 pandemic and to compare it with the diagnostic accuracy of the previously established standard protocol
Summary
Thyroid nodules are very common in the general population (being detected at rates of up to 65%), especially in women,[1] and thyroid cancer is the most common neoplasm of the endocrine system, accounting for about 90% of cases. Most thyroid lesions are benign and the malignant ones account for less than 10%,2 being usually well-differentiated neoplasms with a slow growth and excellent outcomes. FNAC is a cost-effective and useful method for assessing the nature of thyroid nodular lesions[5] characterised by high sensitivity and many advantages such as ready-to-use equipment for a high-quality product, a low rate of complications, and good patient tolerability.[6]. Liquid-based methods for cytology (LBC) have been reported to provide good diagnostic accuracy and are becoming routinely used, either alone or in combination with standard cytological preparation, especially to standardise the preanalytical procedures that are needed to perform immunocytochemistry (ICC) or molecular tests.8-11 Even if there is still some debate regarding the routine application of LBC in thyroid FNAC, it should be noted that this method carries the not negligible advantage of reducing the risk of aerosol diffusion of potentially infected material, which could be of particular value during a pandemic
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