Adequate Fine-needle Aspiration Research Articles

Comparison of Cytological Adequacy between 23- and 25-Gauge in Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: A Single-Center Prospective Study.

Approximately 15% of fine-needle aspiration (FNA) of thyroid nodules are considered nondiagnostic. Several factors are potentially involved, including clinical and nodule features but also the gauge (G) of the needle used. However, few studies have compared the cytological adequacy obtained with different gauge needles and the data are controversial. We aimed to evaluate cytological adequacy results using 23- or 25-G needles. This study is an observational and prospective study of thyroid nodules submitted to ultrasound-guided FNA. The procedure was performed randomly using 23- or 25-G needles. The samples were reported by different cytopathologists who were blinded to the information of the gauge of the needle used. Statistical analysis was performed to compare cytological adequacy of FNA between the two groups. A total of 177 thyroid nodules were included - 98 (55.4%) using 23-G and 79 (44.6%) using 25-G needles. The 23-G group presented a higher rate of cytological adequacy (69.4% [68/98] vs. 46.8% [37/79], p = 0.002). No differences were found between the two groups regarding patient or nodule characteristics. On logistic regression, 23-G needles correlated with better cytological adequacy (unadjusted OR 2.57 [95% CI: 1.39-4.77]), even after adjusting for nodule dimension, location, and type of cytology (slides +/- additional liquid-based cytology) (adjusted OR 2.44 [95% CI: 1.23-4.84]). The gauge of the needle used was found to be an independent predictor of cytological adequacy, with 23-G needles providing more adequate samples. Further investigation is needed to confirm our results in order to stablish the optimal diagnosis technique.

Rapid on-site evaluation (ROSE) of image-guided FNA specimens improves subsequent core biopsy adequacy in clinical trial patients: The impact of preanalytical factors and its correlation with survival.

Sufficient tumor collection has become of utmost importance in therapeutic experimental protocols. Rapid on-site evaluation (ROSE) ensures adequate sampling for quantification of biomarkers, molecular analyses, and other ancillary studies. The objectives of this study were to evaluate the role of ROSE in trial-associated fine-needle aspiration (FNA) and to analyze predictors of adequacy and cumulative survival from in-house FNA cases used in clinical trials. Clinical trial FNA biopsies performed at a large academic institution were analyzed over 10months using a comprehensive chart review of the electronic medical records. SPSS version 28 was used for statistical analysis. Three hundred twenty-five FNAs were collected for 57 clinical trials. In total, 225 individual patients had an average of 1.4 FNA procedures each as a result of a multidepartmental collaborative effort. ROSE was performed for all patients, and adequacy was evaluated by cytotechnologists. Seventy-eight percent of samples were considered adequate, 14% were considered less than optimal, and 8% were considered inadequate, with the latter two categories designated together as less than adequate. The imaging modalities were mainly ultrasound-guided (n=267; 82%) and computed tomography-guided (n=58; 18%). There was a statistically significant association between adequate sampling and ultrasound-guided biopsies (83%) compared with computed tomography-guided biopsies (59%; p<.01). The effect of body mass index (BMI) on mortality was also a significant finding. The authors observed a survival benefit in patients who had elevated BMIs (range, 25.0-34.9 kg/m2 ) compared with those who were underweight (BMI, <18.5 kg/m2 ) or class III obese (BMI, >35.0 kg/m2 ; p<.01). Therefore, the best predictors of adequacy and mortality were imaging modality and BMI, respectively. Ultrasound-guided modalities are recommended for obtaining adequate FNA sampling for clinical trials. In addition, patients with cancer who had slightly elevated BMIs (25.0-34.0 kg/m2 ) had increased overall survival in this cohort.

Evaluating local thyroid cytopathology practices by molecular quality metrics: A multi-institutional study on 4651 FNAs with a focus on the role of the interventional cytopathologist.

The diagnostic accuracy of thyroid fine-needle aspiration (FNA) can be highly influenced by the technical skills of the operator performing the procedure and by interobserver variability in microscopic interpretation. This is particularly true for the indeterminate categories. Recently, molecular testing has been proposed as an ancillary tool for monitoring the performance of different thyroid cytopathology practices. The objective of this multicenter study was to evaluate the quality of different local cytopathology practices by assessing the impact of interventional cytopathologists on FNA adequacy for molecular testing and the variations in mutation rates across different health care centers operating in the Campania region. The study included 4651 thyroid FNA samples diagnosed in different Southern Italian clinical laboratories belonging to the TIRNET (the Tiroide Network). FNA samples were collected by different proceduralists and were classified by local cytopathologists according to The Bethesda System for Reporting Thyroid Cytopathology. FNAs classified as atypia of undetermined significance, follicular neoplasm, suspicious for malignancy, and malignant were centralized for a real-time polymerase chain reaction-based, seven-gene test at the authors' institution. Centers that employed interventional cytopathologists obtained fewer unsatisfactory FNA samples for molecular testing (11.3%) than centers that employed noncytopathologists (16.7%; p<.05). Furthermore, a significant variation in the mutation rate was observed in FNAs diagnosed by different local cytopathologists; indeterminate categories had the highest percentage of mutation rate variability among centers. Interventional cytopathologists obtained higher yields of diagnostic material for molecular testing. Finally, the current results suggest that the variability in mutation rates among different centers may highlight the low reproducibility of microscopic criteria among cytopathologists, particularly for indeterminate cases.

Effects of Rapid On-Site Evaluation on Diagnostic Accuracy of Thyroid Fine-Needle Aspiration

Introduction: Fine-needle aspiration (FNA) is well-established for the evaluation of suspicious thyroid nodules. However, a significant proportion is nondiagnostic. Rapid on-site evaluation (ROSE) has been proposed to improve the overall adequacy of FNA. Methods: Retrospective cohort study comparing adequacy of thyroid FNA findings pre- and postimplementation of ROSE at a tertiary center in Switzerland. Patients undergoing thyroid FNA from January 2016 to December 2019 were included. The primary outcome was the rate of nondiagnostic findings (Bethesda System for Reporting Thyroid Cytopathology category I). Results: In total, 410 thyroid nodule FNAs were performed. Of those, 309 with standard FNA and 101 with ROSE. The majority of patients were female (71%), with a median age of 56 years (IQR 46–68) and a nodule diameter of 1.9 cm (IQR 1.2–2.9). Implementation of ROSE led to a decrease in nondiagnostic findings from 41.1% to 23.8%, with an odds ratio of 0.42 (95% CI: 0.24–0.72; p = 0.002). Implementation of ROSE was associated with significantly higher rates of Bethesda category III (27.7% vs. 19.1%), category IV (15.8% vs. 5.5%), and Bethesda category VI (6.9% vs. 2.3%). Repeated FNA was performed in 29.1% before and 20.8% after implementation of ROSE (p = 0.18). The mean number of FNA per nodule was reduced from 1.4 (0.6) to 1.2 (0.4) with ROSE (p = 0.04). Conclusions: Implementation of ROSE of thyroid nodule specimen improved diagnostic adequacy of FNA, reducing nondiagnostic findings. However, due to increased equivocal findings (Bethesda category III), there was no significant reduction of repeat FNA.

Cytomorphologic findings of low-grade fibromyxoid sarcoma

Low-grade fibromyxoid sarcoma (LGFMS) is a rare fibroblastic tumor characterized by a prolonged clinical course and malignant biological behavior. Given its deceptively bland cytomorphology, a diagnosis can be quite challenging notably on fine-needle aspiration (FNA). In an attempt to shed light on some of the distinctive cytomorphologic characteristics, this study was conducted to review all cases of LGFMS in our database, correlating available clinical data, immunohistochemical findings, and molecular analysis. This series included 20 FNAs from 18 patients with a histologically confirmed LGFMS diagnosis from 3 large academic institutions. Detailed cytomorphologic analysis for each case was documented in conjunction with corresponding clinical characteristics and provided ancillary testing. Out of 14 adequate FNA samples, 9 (64.2%) demonstrated a mixture of fibrous and myxoid pattern; the majority of cases were composed of deceptively bland tumor cells with rare nuclear pleomorphism and nuclear membrane irregularities. A MUC4 immunostain was performed on 5 specimens; all tested positive (100%). FUS rearrangement was detected in 4 out of 5 cases (80%). Follow-up information revealed 5-year recurrence in 1 case and metastatic disease in 2 cases, to the lung/pleura (8 years) and fourth rib (1 year), respectively. The presence of bland spindle cells and associated with myxoid matrix material, in the appropriate clinical setting, can suggest LGFMS and direct additional confirmatory testing. A definitive diagnosis of LGFMS on FNA requires adequate sampling, familiarity with key cytomorphologic features, acquisition of diagnostic material for a cell block preparation and ancillary testing, and clinicoradiologic correlation.

Comparison of routine cytology findings with conventional ziehl-neelsen method and fluorescent method for detection of acid fast bacilli in fine needle aspirates from suspected cases of tuberculous lymphadenitis

Objective: This study aimed to correlate the modified fluorescence stain method and conventional ZN method with routine cytology findings on lymph node aspirates for the detection of AFB in suspected cases of tuberculous lymphadenitis. Material and Methods: After adequate fine needle aspiration, aspirates were examined for cytology diagnosis, studied with Ziehl-Neelsen and Auramine-rhodamine Fluorescent stain. Cytological findings, ZN stain observations and grading were compared with fluorescent stain grading. Result: In our study, 36 cases were reported positive by fluorescent staining method for M. tuberculosis. Out of 43 granulomatous lymphadenitis cases diagnosed by FNAC, 29 cases were reported positive for acid fast bacilli by Z-N staining. 11 cases were found as false negative (22%). Sensitivity and specificity of Z-N method was found to be 70.27% and 76.92% respectively. And for cytological method it was 96.77% and 31.57% respectively. Conclusion: There are problems in arriving at an absolute diagnosis in certain cases of tuberculous lymphadenitis when the aspirate shows polymorphous picture with occasional epithelioid cells and absence of typical Langhans giant cell or caseous necrosis. Microscopy has many advantages when it comes to speed & feasibility, its sensitivity could be improved by adjuvant methods.

Employer Expectations for the MS-Level Cytology Practitioner.

The specific aims of the study are to determine skillsets most valuable to regional employers of cytotechnologists and assess the employers' willingness to use graduating MS cytology practitioners in the expanded scope of practice. Data from the greater New York region were collected via a web-based survey distributed to a broad sample of laboratory professionals involved with hiring in a variety of institutions. The three skillsets most important to New York employers and most employable are fine-needle aspiration adequacy assessment, regulatory acumen, and prescreening cell blocks. The skills that are of least important and least employable are prescreening high-volume tissue biopsy specimens and histology. The results of this survey shed light on regional employers' perspectives regarding the skillsets that are most important and marketable in the greater New York region and may be useful for subsequent curriculum development.

The relationship between the PD-L1 expression of surgically resected and fine-needle aspiration specimens for patients with pancreatic cancer.

Recently, therapeutic antibodies against programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) have shown promising clinical results for several solid tumors, including pancreatic cancer. In this study, we evaluated the relationship between the PD-L1 expression of surgical resected and fine-needle aspiration (FNA) specimens for patients with pancreatic cancer. Of 121 patients who underwent endoscopic ultrasound-guided (EUS)-FNA before surgery for pancreatic cancer in an academic center, the 94 (78%) with adequate FNA specimens for a histological evaluation were retrospectively analyzed. All the patients had undergone upfront surgery without any chemotherapy or radiotherapy. We performed immunohistochemistry (IHC) staining to investigate the PD-L1 expression in both resected and FNA specimens. The positive-stained cells were counted, and their percentage was used for the investigation. Of the 94 patients, 16 (17%) and 11 (10%) were defined as positive on resected cancer specimens using cutoff points of 5% and 10% positively stained cancer cell counts, respectively. The concordance rates for the positive frequency of PD-L1 expression between resected and FNA specimens were 44% (7/16) and 55% (6/11) when the positivity was set to ≥ 5% and ≥ 10%, respectively. The concordance rates for the negative frequency of PD-L1 expression between two specimens were 97% (76/78) and 99% (82/83) when the positivity was set to ≥ 5% and ≥ 10%, respectively. Approximately, half of the patients with PD-L1 expression positive and almost all the patients with PD-L1 expression negative could be diagnosed on FNA specimens.

Myoepithelial carcinoma of the parotid gland: A case of adequate fine-needle aspiration cytology specimens rendering a conclusive diagnosis possible

An 80-year-old male presented with a history of a hard right parotid mass that had gradually increased in size, with subsequent facial paralysis. A fine-needle aspiration biopsy was performed. The cytologic specimens contained a substantial number of sheet-like clusters or small groups of a mixture of plasmacytoid, oval to spindled, or large epithelioid cells having hyperchromatic pleomorphic nuclei, abundant cytoplasm with occasional inclusion body-like materials, and prominent nucleoli, in a relatively clear background. We first interpreted it as a carcinoma, suggestive of myoepithelial differentiation. Radical parotidectomy was performed, and a gross examination of the neoplasm revealed a non-capsulated and ill-defined tumor lesion, with a grayish or yellowish cut surface, associated with fat invasion. On a microscopic examination, the tumor was predominantly composed of the solid proliferation of atypical cells including a mixture of oval to spindled, plasmacytoid, or epithelioid cells, often arranged in a trabecular and reticular growth pattern with patchy eosinophilic hyalinized stroma. Immunohistochemistry showed that the carcinoma cells were specifically positive for p63, cytokeratins, and vimentin. Finally, electron microscopy demonstrated that their phenotype was consistent with a myoepithelial origin containing many bundles of variably thin actin filaments. Therefore, we finally made a diagnosis of myoepithelial carcinoma, defined as the malignant counterpart of benign myoepithelioma. We should be aware that owing to its characteristic cytological features, cytopathologists may be able to make a correct diagnosis of myoepithelial carcinoma, based on multiple and adequate samplings.

Core Needle Biopsy and Fine Needle Aspiration Alone or in Combination: Diagnostic Accuracy and Impact on Management of Renal Masses

Fine needle aspiration with and without concurrent core needle biopsy is a minimally invasive method to diagnose and assist in management of renal masses. We assessed the pathological accuracy of fine needle aspiration compared to and associated with core needle biopsy and the impact on management. We performed a single institution, retrospective study of 342 cases from 2001 to 2015 with small and large renal masses (4 or less and greater than 4 cm, respectively). Diagnostic and concordance rates, and the impact on management were analyzed. Adequacy rates for fine needle aspiration only, core needle biopsy only and fine needle aspiration plus core needle biopsy were 21%, 12% and 8% (aspiration vs aspiration plus biopsy p <0.026). In the aspiration plus biopsy group adding aspiration to biopsy and biopsy to aspiration reduced the inadequacy rate from 23% to 8% and from 27% to 8% for a total reduction rate of 15% and 19%, respectively, corresponding to 32 cases (9.3%). Rapid on-site examination contributed to a 22.5% improvement in fine needle aspiration adequacy rates. In this cohort 30% of aspiration only, 5% of biopsy only and 12% of aspiration plus biopsy could not be subtyped (aspiration vs biopsy p <0.0001, aspiration vs aspiration plus biopsy p <0.0127 and biopsy vs aspiration plus biopsy p = 0.06). The diagnostic concordance rate with surgical resection was 99%. Conversion of an inadequate specimen to an adequate one by a concurrent procedure impacted treatment in at least 29 of 32 patients. Limitations include the retrospective design and accuracy measurement based on surgical intervention. Fine needle aspiration plus core needle biopsy vs at least fine needle aspiration alone may improve diagnostic yield when sampling renal masses but it has subtyping potential similar to that of core needle biopsy only.

Improving Adequacy of Small Biopsy and Fine-Needle Aspiration Specimens for Molecular Testing by Next-Generation Sequencing in Patients With Lung Cancer: A Quality Improvement Study at Dartmouth-Hitchcock Medical Center.

- At our medical center, cytopathologists perform rapid on-site evaluation for specimen adequacy of fine-needle aspiration and touch imprint of needle core biopsy lung cancer samples. Two years ago the molecular diagnostics laboratory at our institution changed to next-generation sequencing using the Ion Torrent PGM and the 50-gene AmpliSeq Cancer Hotspot Panel v2 for analyzing mutations in a 50-gene cancer hot spot panel. This was associated with a dramatic fall in adequacy rate (68%). - To improve the adequacy rate to at least 90% for molecular testing using next-generation sequencing for all specimens collected by rapid on-site evaluation by the cytology laboratory. - After baseline data on adequacy rate of cytology specimens with rapid on-site evaluation for molecular testing had been collected, 2 changes were implemented. Change 1 concentrated all the material in one block but did not produce desired results; change 2, in addition, faced the block only once with unstained slides cut up front for molecular testing. Data were collected in an Excel spreadsheet and adequacy rate was assessed. - Following process changes 1 and 2 we reached our goal of at least 90% adequacy rate for molecular testing by next-generation sequencing on samples collected by rapid on-site evaluation including computed tomography-guided needle core biopsies (94%; 17 of 18) and fine-needle aspiration samples (94%; 30 of 32). - This study focused on factors that are controllable in a pathology department and on maximizing use of scant tissue. Optimizing the adequacy of the specimen available for molecular tests avoids the need for a second procedure to obtain additional tissue.

Rapid On-Site Evaluation Does Not Improve Endoscopic Ultrasound-Guided Fine Needle Aspiration Adequacy in Pancreatic Masses: A Meta-Analysis and Systematic Review.

Background and ObjectivesRapid on-site evaluation (ROSE) during endoscopic ultrasonography-guided fine needle aspiration (EUS–FNA) of pancreatic masses has been reported to be associated with improved adequacy and diagnostic yield. However, recent observational data on the impact of ROSE have reported conflicting results. A meta-analysis and systematic review was therefore conducted to evaluate the contribution of ROSE during EUS-FNA of pancreatic masses.MethodA systematic search was conducted in MEDLINE/Pubmed and EMBASE databases for studies comparing the efficacy of ROSE between patients in two cohorts. Outcomes considered included diagnostic adequate rate, diagnostic yield, number of needle passes, pooled sensitivity and specificity. Findings from a random-effects model were expressed as pooled risk difference (RD) with 95% confidence intervals (CIs).ResultsA total of 7 studies (1299 patients) was finally included and further analyzed in the current meta-analysis. EUS-FNA with ROSE could not improve diagnostic adequacy (RD = 0.05, 95% CI: -0.01–0.11) and diagnostic yield (RD = 0.04 95%CI: -0.05, 0.13). The number of needle passes showed no statistically significant difference with and without ROSE (RD = -0.68 95%CI: -2.35, 0.98). The pooled sensitivity and specificity of ROSE group were 0.91 (95%CI: 0.87, 0.94) and 1 (95%CI: 0.94, 1.00). The pooled sensitivity and specificity of non-ROSE group were 0.85 (95%CI: 0.80, 0.89) and 1 (95%CI: 0.95, 1.00). ROSE group and non-ROSE group showed comparable sensitivity and specificity.ConclusionCompared to historical reports of its clinical efficacy in patients with pancreatic lesions, ROSE may be not associated with an improvement of diagnostic yield, adequate rate, pooled sensitivity and specificity.

Cystadenocarcinoma of the minor salivary gland arising in the upper lip: A surgical case of an inadequate cytology specimen hampering conclusive diagnosis

Cystadenocarcinoma (CAC) of the salivary gland poses a diagnostic challenge to us, as this uncommon entity is extremely difficult to diagnose pre-operatively on an inadequate sample. However, markedly few papers have described the cytological features of CAC. An 82-year-old male presented with a history of a gradual increase in size and occasional mucous drainage from a swollen reddish nodule on the right upper lip. A retrospective examination of the cytological specimens from the drainage revealed a small number of clusters and scattered single cells of severely degenerated and mildly atypical epithelial cells with hyperchromatic dense nuclei and abundant clear cytoplasm, in a background of a large amount of mucinous material. We first interpreted this finding merely as the presence of atypical cells. However, a gross examination revealed a non-capsulated and relatively well-demarcated cystic lesion, grayish to whitish in color and measuring 13×9mm in diameter, filled with mucin. A microscopic examination showed that the tumor had a central cystic cavity filled with mucinous material and was predominantly composed of the papillary proliferation of atypical columnar mucous epithelial cells with enlarged hyperchromatic nuclei, mixed with mitotic hot spots often projecting and melting into the mucinous cystic lumen, and focally involving the surrounding connective tissue. Therefore, we ultimately made a diagnosis of CAC of the minor salivary gland arising in the upper lip. Given the characteristic features of CAC, cytopathologists should be able to correctly diagnose this lesion based on multiple adequate fine needle aspiration samples.

Do immediate cytology and specialist radiologists improve the adequacy of ultrasound-guided fine-needle aspiration cytology?

To assess whether a dedicated "1-stop" neck lump clinic has improved the percentage of adequate fine-needle aspiration cytology (FNAC) samples and reduced the need for repeat FNAC. Retrospective review. District General Hospital in the United Kingdom. Patients attending for ultrasound-guided FNAC over a 6-month period from August 2012 to February 2013. Patients were placed in 4 groups: group 1, FNAC performed by any of the subspecialist radiologists with cytology support (n = 100); group 2, FNAC performed by general radiologists without cytology support (n = 112); group 3, FNAC performed by a particular subspecialist radiologist with cytology support (n = 61); and group 4, FNAC performed by the same subspecialist radiologist without cytology support (n = 125). There was a significantly higher rate of adequacy of FNAC in the presence of a subspecialist radiologist with immediate cytology (group 1) versus a general radiologist without cytology support (group 2; 87/100 vs 63/112, P = .0001), a significantly higher rate of adequacy of FNAC in the presence of cytology support with the same radiologist (group 3 vs group 4, 55/61 vs 97/125, P = .04), and a significantly higher rate of adequacy of FNAC in the presence of a subspecialist radiologist versus a general radiologist without cytology support (group 4 vs group 2, 97/125 vs 63/112, P = .0005). Immediate cytology and the presence of a subspecialist radiologist increase the adequacy of FNAC. The adequacy rate of non-cytology-supported FNAC or nonsubspecialist FNAC is below the adequate rate expected from the literature or as recommended in national guidelines.

A feasibility study of full-field optical coherence tomography for rapid evaluation of EUS-guided microbiopsy specimens

Rapid on-site evaluation of cytologic specimens is a way of determining the adequacy of fine-needle aspiration (FNA). However, alternatives may be useful when the presence of a cytotechnologist and/or pathologist is not possible. To evaluate the feasibility of using full-field optical coherence tomography (FFOCT) for FNA specimen quality assessment. FFOCT images were acquired on gastric, pancreatic, pelvic, and lymph-node formalin-fixed FNA specimens and were compared with histology of the same samples. Pathology suite in a hospital. Fourteen patients undergoing gastric, pancreatic, pelvic, or lymph-node EUS-guided FNA biopsy. FFOCT imaging on formalin-fixed samples before histologic procedures. FFOCT imaging feasibility and visibility of normal and abnormal features on images. FFOCT imaging was possible. Blood, mucus, muscle, collagen, and digestive mucosa could be identified as well as abnormal architectural features including infiltrative pancreatic ductal carcinoma and a neuroendocrine neoplasm. Lesions at the individual cell level could not be detected. The study was performed on a limited number of cases. FFOCT offers rapid, noninvasive, nondestructive imaging of FNA biopsy specimens. In the future, it could be performed in the endoscopy suite to improve detection of satisfactory specimens and obviate the need for rapid on-site evaluation.

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

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.

Thyroid core needle biopsy: taking stock of the situation.

Recently, the microhistologic evaluation by core needle biopsy (CNB) has been reported as high accurate to diagnose thyroid nodules with previous indeterminate or not adequate fine-needle aspiration cytology. In addition, sparse data have been reported regarding the use of CNB in other conditions. Aim of this review was to furnish the state of the art of this topic by summarizing published data about the diagnostic performance of CNB in thyroid lesions, and provide an easy to use reference for clinical practice. Sources encompass studies published through May 2014. Original articles were investigated and following specific aspects were discussed: 1. The "large" needle biopsy in 90's; 2. Complications by and patient's comfort with thyroid CNB; 3. Advantages provided by examination of a microhistologic sample of thyroid nodule; 4. Use of CNB in thyroid nodules with previous not adequate (Thy 1/Class 1/Category I) cytology; 5. Use of CNB in thyroid neoplasms (Thy 3/Class 3/Category III-IV) cytology; 6. Use of CNB in specific ultrasonographic presentations of thyroid nodules or in patients with peculiar clinical contexts; 7. First-line approach by CNB in thyroid nodules; 8. Immunohistochemistry and molecular tests on CNB samples; and 9. Future perspective.

On-site cytotechnician evaluation of the adequacy of fine needle aspiration in a neck lump clinic

The gold standard for assessing neck lumps is a one-stop clinic with an on-site cytopathologist who can provide an immediate fine needle aspiration (FNA) report. However, this has considerable resource implications and is not available in all units. In our department, surgeons perform FNAs guided by palpation. The FNA is evaluated for specimen adequacy by an on-site cytotechnician. This study evaluated the impact of the cytotechnician on the adequacy of neck lump FNA. FNA performed between June 2010 and February 2012 was examined. The FNA performed at a neck lump clinic with an assessment of adequacy by an on-site cytotechnician were considered the test group. All other neck lump FNAs from other sources without an assessment of adequacy by an on-site cytotechnician were considered the control group. Of the FNAs, 134 met the inclusion criteria for this study. Of these, 87 FNAs (65%) were analysed for adequacy by the on-site cytotechnician and the remaining 47 (35%) were not. The results demonstrated an FNA inadequacy with and without on-site cytotechnician assessment of 29.9% and 40.4% respectively. This is equivalent to an absolute risk reduction of an inadequate FNA of 10.5%, which equates to a number needed to treat of 9.5, ie the cytotechnician needs to assess 9.5 (ie the cytotechnician [...] specimen). In neck lump clinics where on-site cytopathology is not available, an on-site cytotechnician is a compromise measure that does reduce the number of inadequate FNAs.

On-site cytotechnician evaluation of the adequacy of fine needle aspiration in a neck lump clinic

The gold standard for assessing neck lumps is a one-stop clinic with an on-site cytopathologist who can provide an immediate fine needle aspiration (FNA) report. However, this has considerable resource implications and is not available in all units. In our department, surgeons perform FNAs guided by palpation. The FNA is evaluated for specimen adequacy by an on-site cytotechnician. This study evaluated the impact of the cytotechnician on the adequacy of neck lump FNA. FNA performed between June 2010 and February 2012 was examined. The FNA performed at a neck lump clinic with an assessment of adequacy by an on-site cytotechnician were considered the test group. All other neck lump FNAs from other sources without an assessment of adequacy by an on-site cytotechnician were considered the control group. Of the FNAs, 134 met the inclusion criteria for this study. Of these, 87 FNAs (65%) were analysed for adequacy by the on-site cytotechnician and the remaining 47 (35%) were not. The results demonstrated an FNA inadequacy with and without on-site cytotechnician assessment of 29.9% and 40.4% respectively. This is equivalent to an absolute risk reduction of an inadequate FNA of 10.5%, which equates to a number needed to treat of 9.5, ie the cytotechnician needs to assess 9.5 (ie the cytotechnician [...] specimen). In neck lump clinics where on-site cytopathology is not available, an on-site cytotechnician is a compromise measure that does reduce the number of inadequate FNAs.

Expanding the entry-level competencies for cytotechnology programs: Broadening horizons

Faced with rapid changes in the cytopathology workplace, a number of expanded entry-level competencies (ELCs) were developed by the Cytotechnology Programs Review Committee with input from various communities of interest. The Resource Sub-Committee of the Cytotechnology Programs Review Committee was developed to assist the programs in finding appropriate resources to bring cytotechnology programs up to more modern standards of practice. A survey was conducted asking program directors to rank their level of perceived need for each of the new ELCs. Interpretation of the relative need for these resources was based on a 4-tier system. If the program directors' felt they had or could obtain adequate resources, these 2 responses were given a lower weighting in the analysis. If the program was not already teaching the topic and did not have access to appropriate resources, the response was ranked as indicating a high level of need. An intermediate level of need was indicated by a perceived need to strengthen the resources for a topic currently being taught. A 97% response rate was obtained on the survey and an evaluation of the ELCs, which indicated a high level of need that included telepathology, digital pathology, laboratory information systems, billing and coding, and triage of fine-needle aspiration specimens. Low levels of need were indicated for Health Insurance Portability and Accountability Act issues, proficiency testing, workload recording, obtaining clinical information, and fine-needle aspiration adequacy reporting. Other topics were ranked as intermediate in perceived need for resources. Efforts by the subcommittee are currently underway to provide these resources to improve the educational programs in cytotechnology.