Who Should Perform Rapid or On-Site Assessment of Thyroid Fine-Needle Aspirations?

Abstract

The reasons for performing on-site or immediate assessment of adequacy with fine-needle aspiration (FNA) include higher rates of adequacy, fewer patient complications (fewer passes and procedures may be needed), and conducting proper triage of specimens and patients. Less commonly addressed reasons include fellowship and residency training (our fellows and residents believe this to be one of the most important aspects of their cytology training) and interphysician communication (on-site interpretation of FNAs may allow some pathologists to become better acquainted with clinical colleagues and hospital staff in general, and provide them with helpful information for specific cases). A number of articles addressing the importance of on-site or rapid assessment of FNA specimens have been published and most attest to its usefulness.1–5 Some argue that the time required to obtain a greater number of adequate specimens may be extensive and poorly reimbursed though worthwhile in a more global sense of medical expense.2,6 Articles addressing its usefulness have been far from perfect, and even as an advocate of the procedure I do not find the literature overwhelmingly convincing. Often a number of uncontrolled factors may be playing a role in the final adequacy assessments in some studies, eg, the aspirates in one group have been performed at a different physical location or by different physicians or are of different anatomic sites or disease states, etc, than those of the other group. We interpret almost all FNAs performed …