Does Immediate Cytology Improve the Adequacy of Ultrasound‐Guided FNAC?

Abstract

Objectives: Assess whether a dedicated “one stop” neck lump clinic has helped to improve the percentage of adequate fine-needle aspiration cytology (FNAC) samples and reduce the need for repeat FNAC. Methods: Retrospective review of patients attending for ultrasound-guided FNAC over a 6-month period from August 2012 to February 2013. Patients were placed within 2 groups (Group 1: FNAC performed by any of the subspecialist radiologists with cytology support (n = 100) and Group 2: FNAC performed by general radiologists without cytology support (n = 112)). In order to test for intra-observer agreement, 2 further groups were added (Group 3: FNAC performed by particular subspecialist radiologist with cytology support (n = 61) and Group 4: FNAC performed by the same subspecialist radiologist without cytology support (n = 125). Results: Seventy-four percent of neck lumps originated from the thyroid, 13% from the salivary glands, and 4% from lymph nodes. Adequacy rates of FNAC in Group 1 were 87% as compared with 56% in Group 2. Adequacy rates of FNAC in Group 3 were 90% as compared with 78% in Group 4. Thus, the presence of immediate cytology and a subspecialist radiologist increased FNAC adequacy by 31%. The presence of cytology support increased adequacy by 12% and presence of a subspecialist radiologist increased adequacy by 22%. Conclusions: Immediate cytology and the presence of a subspecialist radiologist increase the adequacy of FNAC. The adequacy rate of noncytology supported FNAC or nonsubspecialist FNAC is below the adequate rate expected from the literature or as recommended in national guidelines.