The case for pathologist ultrasound-guided fine-needle aspiration biopsy

Abstract

O ne of the questions considered at the ‘‘National Cancer Institute (NCI) Thyroid Fine Needle Aspiration State of the Science Conference’’ held October 22 through 23, 2007, is whether ultrasound guidance should be used during the fine-needle aspiration (FNA) biopsy of a thyroid nodule. I would like to make the case that the answer to the question of ultrasound-guided FNA (USGFNA) is ‘‘absolutely yes,’’ if the pathologist has a strong clinical interest and desire to improve his patients’ care. This answer is given from the point of view of an experienced FNA pathologist who, for a while, resisted ultrasound (US) technology. After all, if, in 20 years of practice, I had consistently obtained seemingly fully diagnostic samples by physical examination and manual FNA sampling, what then could US add? However, after only a few months of using US in my clinic, I quickly came to understand that US imaging does improve patient care. US imaging greatly augments the physical assessment of the thyroid, which often only vaguely reflects the underlying anatomic reality. Moreover, USGFNA allows for precise and selective needle placement during the biopsy. If a pathologist already has the experience, dexterity, and passion to perform a quality biopsy via traditional methods and to make quality smears, then, he or she can easily learn to perform USGFNA on some or all cases. Although formal training is optimal and will be detailed below, the basic technique can be acquired from hands-on training, often provided by the US equipment manufacturer as a condition of sale. Also, many of us who have already incorporated US guidance into our practices will gladly tutor our colleagues in the techniques during visits to the clinic. In addition, practice US phantoms are wonderfully uncomplaining practice objects on which the pathologist can sharpen his US guidance skills until the motions are automatic. A phantom is a commercially available object constructed of rubber and plastic in the form of a body part, such as a breast, that contains US detectable objects of varying sizes, shapes, and depths. Examples include the Blue Phantom (available at: http://www.bluephantom.com/) and the Ultra/Phonic BP Breast Phantom (available at: http://www. pharminnovations.com). Early in my US self-training, I would come I greatly appreciate the assistance of Mr. David Geller in editing this article.