Cytopathologist‐performed ultrasound‐guided fine‐needle aspiration and core‐needle biopsy: A prospective study of 500 consecutive cases

Abstract

In experienced hands, palpation-guided fine-needle aspiration is an excellent diagnostic tool. However, there is a movement toward using imaging guidance to target all masses. This study examines the feasibility of cytopathologist-performed ultrasound-guided FNA (UG-FNA) and ultrasound-guided core-needle biopsy (UG-CNB) of masses in the breast, thyroid, head and neck, and other superficial sites. Between January 8, 2007 and June 28, 2007, 415 consecutive patients with 500 masses that were (1) nonpalpable (2) palpable but sonographically heterogeneous requiring ultrasound guidance to target the abnormal areas, or (3) palpable but located near a structure to be avoided underwent cytopathologist-performed UG-FNA and/or UG-CNB. There were 395 (79%) nonpalpable masses and 105 (21%) palpable masses. The nondiagnostic rate was 1.4%. All cases undergoing both FNA and CNB were diagnostic. With continuing medical education in radiology and ultrasound-guided procedures, training on phantoms, and practice on palpable masses before transition to nonpalpable masses, the author was able to successfully perform UG-FNA/CNB of nonpalpable masses and targeted UG-FNA/CNB of palpable masses. In the hands of the cytopathologist, ultrasound guidance offers a new tool to revitalize and redefine the role of the interventional cytopathologist. A new era in cytopathology and fine-needle aspiration may be on the horizon.