Palpation-guided Fine-needle Aspiration Research Articles

Diagnostic workup of triple hit lymphoma by fine needle aspiration

Abstract Introduction/Objective Triple-hit lymphomas (THL) represent a rare and aggressive subset of high-grade B-cell lymphomas characterized by a triad of translocations involving MYC, BCL2, and BCL6. Patients with THL face poor outcomes when treated with the standard diffuse large B-cell lymphoma protocol. Thus, intensified regimens have emerged as a frontline strategy for managing these patients. Therefore, accurate diagnosis and molecular subclassification of these lymphomas are essential for guiding therapeutic decisions for these patients. Here, we report a case study detailing the diagnostic assessment of THL utilizing limited diagnostic material obtained through palpation-guided fine-needle aspiration (FNA). Methods/Case Report A 58-year-old male presented with a rapidly enlarging neck mass, accompanied by worsening dysphagia, pain, and fatigue over the course of two months. Laboratory testing showed leukocytosis and imaging studies revealed a partially necrotic, 7.8 x 9.1 x 9.4 cm right jugular nodal mass. The patient was referred to otolaryngology for further evaluation, where FNA of the mass was performed by the cytopathology team. The aspirate was sent for cytology with cell block and flow cytometry. The Romanowsky stain revealed abundant, large, discohesive cells with prominent nucleoli and scant cytoplasm with an abundance of lymphoglandular bodies in the background. Immunohistochemistry (IHC) on the cell block demonstrated BCL-2, BCL-6, and MYC expression, and a Ki-67 proliferation index >95%. Concurrent flow cytometric analyses showed an aberrant B-cell population expressing CD19, CD20, CD22, CD23 and surface lambda light chain. Further fluorescence in situ hybridization (FISH) analysis performed on the cell block confirmed gene rearrangements in BCL2, BCL6 and MYC, thereby classifying this patient’s disease as THL. Results (if a Case Study enter NA) NA Conclusion Diagnosing THL typically demands sufficient tissue for histology, cytology, flow cytometry, IHC, and molecular testing. Herein, we showcase a notable example where the diagnostic evaluation of THL was accomplished using limited material obtained from FNA. This case highlights the efficacy of conducting comprehensive diagnostic studies even when tissue availability is constrained. Utilizing cytologic samples not only streamlines the diagnostic process but also minimizes the need for patients to undergo additional invasive procedures, thus potentially reducing delays in diagnosis and therapeutic intervention.

FNA 2.0: Value of cytopathologist-performed ultrasound-guided core-needle biopsy.

In the late 20th century, pathologist-performed palpation-guided fine-needle aspiration (PG-FNA) of superficial masses was popularized in the United States. It brought pathologists out of the laboratory to see patients and the hope of decreasing the need for surgical biopsy for diagnostic purposes. This first iteration of minimally invasive tissue sampling could be informally called FNA 1.0. FNA 1.0 had shortcomings, such as detection of invasion in breast cancer, precise subtyping of lymphomas, aspiration of fibrous lesions, and diagnosis of sarcomas. The early 21st century brought new hope. Ultrasound-guidance became commonly used to guide FNA of both palpable and non-palpable masses. Ultrasound-guided core-needle biopsy was available to complement FNA in select cases. Flow cytometry, immunohistochemistry, fluorescent in-situ hybridization, and genomic studies could be done on cell block and core biopsy specimens. These advances in minimally invasive tissue diagnosis could be informally called FNA 2.0. In particular, pathologist-performed ultrasound-guided core-needle biopsy can overcome many of the criticisms and shortcomings of FNA. As pathologists were once leaders in palpation-guided fine-needle aspiration, they now have the opportunity to add pathologist-performed ultrasound-guided core-needle biopsy to their skill set and emerge once again as leaders in minimally invasive tissue diagnosis. This will bring pathology to the next level.

Effects of COVID-19 pandemic on cytology: specimen adequacy in fine-needle aspiration of palpable head and neck masses.

IntroductionAt our institution, palpation-guided fine-needle aspiration (FNA) is performed by the cytopathology service on an outpatient basis at the request of otolaryngologist surgeons. The aim of this study is to assess the effect of COVID lockdown measures on our FNA service with specific focus on adequacy rates.Materials and methodsAll palpation-guided FNA performed in 2019 to 2020 were identified in our pathology database. Adequacy rates were compared for 3 time periods in 2020: pre-COVID, lockdown, and post-lockdown.ResultsIn 2019, 121 FNAs were performed with 98% (119 of 121) obtained by pathology and only 2% (2 of 121) obtained by surgeons. In 2020, 89 FNAs were performed with 45% (40 of 89) collected by pathologists and 55% (49 of 89) by surgeons. During the pre-COVID period of 2020, 27 FNAs were collected, 85% (23 of 27) by pathologists, 8.7% of these (2 of 23) were nondiagnostic. Of the 4 FNAs performed by surgeons, all were positive for malignancy. During COVID lockdown all 24 FNAs were performed by surgeons with a 50% (12 of 24) nondiagnostic rate. Post-lockdown, with FNA referrals still below pre-COVID levels, surgeons performed 55.3% (21 of 38) of FNAs with 28.6% (6 of 21) non-diagnostic, while pathology performed 44.7% (17 of 38) with an 11.8% (2 of 17) nondiagnostic rate.ConclusionsOur FNA service noted significant changes in 2020 as a result of the COVID pandemic. Nondiagnostic rates were significantly increased in 2020 compared with 2019, primarily due to a shift to majority surgeon-performed palpation-guided FNA in the absence of cytopathology service during the lockdown period.

Effects of COVID-19 Pandemic on a Cytology Service: Specimen Adequacy in Palpation-guided Fine Needle Aspiration

Effects of COVID-19 Pandemic on a Cytology Service: Specimen Adequacy in Palpation-guided Fine Needle Aspiration

Diagnostic accuracy of preoperative palpation- versus ultrasound-guided thyroid fine needle aspiration cytology: an observational study

ABSTRACT Background Thyroid fine needle aspiration (FNA) is the mainstay for diagnosis of malignancy, and is an integral part of current thyroid nodule assessment. The present study analyzes the diagnostic accuracy of palpation-directed versus ultrasound guided fine-needle aspiration in patients who underwent surgery for thyroid nodules. Methods A retrospective chart review of all consecutive patients who had FNA biopsy (palpation or ultrasound guided) of thyroid nodules and underwent thyroid gland surgery between 1998 and 2014 was conducted. The FNA findings of the palpation-guided and ultrasound-guided groups were compared for baseline characteristics. Moreover, the diagnostic accuracy of FNA findings and surgical histopathology results were analyzed. Results A total of 1174 patients were included in the study with a mean age of 46.3 ± 11.7 years and the majority were females (75.5%). Among the study population, 392 (33.4%) patients underwent US-guided FNA; 570 (48.6%) had palpation-guided FNA in clinic and no FNA was done in 212 (18%) cases. Patients underwent US-guided FNA were more likely to have suspicion of malignancy (p = 0.001), and had indeterminate findings (p = 0.001). On the other hand, palpation-guided FNA group had significantly higher frequency of benign cytology (p = 0.001). With respect to the suspicion for malignancy as well as malignancy, the US-guided group had a similar diagnostic accuracy in comparison to the palpation group. The proportion of malignancy finding on US-guided FNA (8.9%) was higher than the palpation-guided FNA (6.4%) that had been confirmed on postoperative histopathological examination (p = 0.95). Conclusion The present study demonstrates higher sensitivity of US-guided thyroid FNA biopsies over palpation-guided FNA for the suspicion of malignancy; however, the accuracy is comparable. Moreover, both groups showed more postoperative malignancy in the benign and unsatisfactory categories than predicted in the Bethesda system. Further prospective studies are needed to underpin a realistic correlation between FNA and final histopathology reports.

Fine-needle aspiration biopsy of thyroid nodules: Is routine ultrasound-guidance necessary?

Current guidelines recommend either ultrasound-guided or palpation-guided fine-needle aspiration biopsy for evaluation of a thyroid nodule. However, it has been suggested that ultrasound-guided fine-needle aspiration biopsy should be used routinely in all patients to reduce the rate of nondiagnostic and false negative results. The purpose of this study was to determine whether any difference exists in nondiagnostic and false negative rates between the two methods of fine-needle aspiration biopsy at our institution. A retrospective review of a prospectively maintained thyroid database was completed to determine the rates of nondiagnostic and false negative fine-needle aspiration biopsy in patients with nodular thyroid disease evaluated during the period 1990-2017. From 1990 to 2017, a total of 2,322 patients underwent fine-needle aspiration biopsy for evaluation of nodular thyroid disease, 1,123 (48%) underwent ultrasound-guided fine-needle aspiration biopsy and 1,199 (52%) underwent palpation-guided fine-needle aspiration biopsy. Ultrasound-guided fine-needle aspiration biopsy was nondiagnostic in 4.5% and had a 5.2% false negative rate, compared with palpation-guided fine-needle aspiration biopsy, which was nondiagnostic in 5.0% and had a 2.6% false negative rate (P = .53 and .14, respectively). The rate of nondiagnostic and false negative fine-needle aspiration biopsy results is similar whether US guidance is used or not. To minimize resource utilization, ultrasound-guided fine-needle aspiration biopsy can be used selectively for nonpalpable, predominantly cystic, or previously nondiagnostic nodules.

The use of fine needle aspiration and trends in incidence of thyroid cancer in Taiwan

BackgroundThyroid cancer is the most prevalent endocrine malignancy, and the incidence of thyroid cancer has increased worldwide. Fine needle aspiration (FNA) for cytology of thyroid tissue is used for differentiating thyroid cancers from benign thyroid nodules. Overuse of FNA may detect subclinical thyroid cancer and play a role in the increased incidence of thyroid cancer. The aim of this study was to evaluate trends in incidence of thyroid cancer and the use of palpation-guided FNA thyroid and ultrasound-guided FNA thyroid in Taiwan. MethodsBy retrospectively analyzing a cohort dataset of one million people randomly sample to represent as NHI beneficiaries of Taiwan National Health Insurance Research Database from 2004 to 2010, patients who received palpation-guided and ultrasound-guided thyroid FNA were identified. Individuals who were diagnosed as having thyroid cancer were determined. Age-standardized, yearly rates of palpation-guided thyroid FNA and ultrasound-guided FNA, and age-standardized, yearly incidence rates of thyroid cancer were calculated. ResultsIn the study period, a total of 541 patients were newly diagnosed with thyroid cancer, 14,240 individuals received palpation-guided thyroid FNA, and 3823 individuals underwent ultrasound-guided thyroid FNA. There was a 94.8% increase in the age-standardized annual incidence rate of thyroid cancer. The age-standardized rates of palpation-guided thyroid FNA and ultrasound-guided thyroid FNA increased by 10.9% and 349.3%, respectively. ConclusionFNA for cytology of thyroid tissue, especially ultrasound-guided FNA, was conducted by physicians more frequently in Taiwan. Increased use of FNA, especially ultrasound-guided FNA for cytology of thyroid tissue, may attribute to the increased incidence of thyroid cancer in Taiwan.

Breast imaging after dark: patient outcomes following evaluation for breast abscess in the emergency department after hours.

In our study, we sought to report the management, clinical outcomes, and follow-up rates of patients who presented for evaluation of breast abscess in the Emergency Department (ED) after hours. A retrospective search of ultrasound reports at our institution identified all patients from January 1, 2009 to June 30, 2013 who were scanned in the ED after hours to evaluate for breast abscess. Patient demographics, clinical information, imaging findings, follow-up rates, and outcomes were reviewed. One hundred eighty-five patients were included in the study. Forty-four percent (86/185) of the patients were diagnosed with abscess based on ultrasound findings in the ED. Twenty-seven percent (23/86) were recently post-operative, and 12 % (10/86) were postpartum/breastfeeding. Mastitis was the diagnosis in the remaining 54 % (99/185). Only 1/86 cases were associated with breast cancer. Seventy-seven percent (66/86) of patients were treated with an invasive procedure; 39 % (26/66) had surgical evacuation, 30 % (20/66) image-guided drainage, 23 % (15/66) bedside or clinic incision and drainage, and 8 % (5/66) palpation-guided fine needle aspiration (FNA). Seventy-seven percent (143/185) of patients had clinical and/or imaging follow-up. Forty-four percent (63/143) had long-term follow-up (≥ 3 months). Almost 50 % of the patients who presented to the ED for evaluation of abscess were diagnosed with abscess while the remaining patients were diagnosed with mastitis. Appropriate clinical and/or imaging follow-up occurred in 77 %. Long-term follow-up (≥ 3 months) occurred more frequently in patients older than 30 years of age. Appropriate follow-up does not occur in approximately one fourth of cases, suggesting that additional clinician and patient education is warranted.

Factors Influencing the Reliability of Thyroid Fine-Needle Aspiration: Analysis of Thyroid Nodule Size, Guidance Mode for Aspiration and Preparation Method

Objective: We aimed to clarify the influence of ThinPrep preparation, nodule size and guidance mode on the accuracy of thyroid fine-needle aspiration (FNA). Methods: A total of 1,240 thyroid FNAs were reviewed and 489 cases with histological correlations were enrolled in this study. Results: Of the 489 total cases examined, 101 were processed with both ThinPrep and conventional preparation and 388 entirely with ThinPrep. The overall nondiagnostic rate, sensitivity and accuracy of FNA were 2.0, 91.0 and 89.4%, respectively. The cases with a preoperative ultrasound (n = 469) were grouped according to nodule size. The nondiagnostic rate, sensitivity and accuracy of FNA did not differ significantly with nodule size (p1 = 0.339, p2 = 0.179, p3 = 0.119). A total of 101 resections were performed with palpation-guided FNA and 388 were performed with ultrasound-guided FNA. The nondiagnostic rates, sensitivity and accuracy of FNA were similar in these two groups. Conclusions: The ThinPrep technique is a valid method for thyroid FNA and is effective for thyroid nodules ≥0.5 cm. The reliability of FNA results is not reduced with larger nodules. The use of palpation-guided FNA for palpable solid nodules is also effective.

Advances in head and neck fine-needle aspiration and ultrasound technique for the pathologist.

The success of fine-needle aspiration (FNA) biopsy in the evaluation of head and neck (H&N) masses has already been established. Herein we outline the most recent advancement for the pathologist who performs traditional palpation-guided FNA (PGFNA) in the H&N while also incorporating ultrasound-guided FNA (UGFNA) into their practice. We provide an overview of the educational and training opportunities in H&N ultrasound and UGFNA with emphasis on the advantages and limitations for the pathologist. Throughout are useful clinical and technical pearls, many of which may also interest those who practice PGFNA, including local anesthesia use and FNA procedures in pediatric patients.

A systematic review and meta-analysis of palpation versus ultrasound-guided fine needle aspiration of thyroid nodules

Background: Thyroid nodules are a common clinical finding. Fine-needle aspiration (FNA) is the most widely accepted diagnostic tool used to differentiate malignant and benign thyroid nodules. FNA can be carried out by manual palpation of the nodule or with ultrasound guidance. Existing clinical practice guidelines give mixed recommendations regarding the use of ultrasound guidance for thyroid FNA. Given the inconsistencies in the guidelines, we performed a systematic review and meta-analysis to compare the diagnostic accuracy of palpationguided fine needle aspiration (PG-FNA) versus ultrasound-guided fine needle aspiration (USG-FNA). Methods: Studies comparing PG-FNA and USG-FNA were identified through a search of PubMed, the Cochrane Library, and Embase (1990- December 2011). Titles and abstracts were reviewed and studies were selected for a full text review. Meta-analysis of included studies was performed to estimate the average sensitivity, specificity, and rate of inadequate samples for each technique. Results: We screened 1934 citations and selected seven studies meeting our predefined inclusion criteria. The pooled sensitivity of USG-FNA was found to be higher than PG-FNA [0.91 (CI=0.82, 1.0) and 0.79 (CI=0.69, 0.85), respectively]. The pooled specificity of USG-FNA was also found to be slightly higher than PG-FNA [0.77 (CI=0.69, 0.85) and 0.73 (CI=0.64, 0.81), respectively]. The mean rate of inadequate samples was higher for PG-FNA at 14.7% versus 8.4% for US-FNA. Conclusions: Our findings show that USG-FNA has a higher diagnostic accuracy than PG-FNA and a lower rate of inadequate samples. Overall, these findings suggest an advantage to the use of USG-FNA over PG-FNA.

Ultrasound-Guided Fine-Needle Aspiration Biopsy

Ultrasound-Guided Fine-Needle Aspiration Biopsy

Comparison of Inadequacy Rates of Palpation Versus Ultrasound Guided Fine Needle Aspiration Biopsy of Thyroid Nodules

Fine needle aspiration (FNA) is the optimal diagnostic test for evaluating thyroid nodules for malignancy. Ultrasound guided FNA (USGFNA) is more commonly performed and is more resource intensive compared to palpation guided FNA (PGFNA). The purpose of this study was to compare inadequacy rates of PGFNA versus USGFNA of thyroid nodules.

Thyroid nodule sonography: assessment for risk of malignancy

Fine-needle aspiration (FNA) is the most reliable diagnostic tool for diagnosing thyroid cancer and should be performed on nodules considered suspicious. Traditionally, thyroid nodules were discovered by physical examination of the neck and underwent palpation-guided FNA in the physician’s office when malignancy was of concern. In recent years, the use of high-resolution neck sonography to examine the thyroid has resulted in the detection of many nonpalpable nodules. Although the majority of these nodules are benign, their discovery results in the need to determine if FNA should be performed on one or more of these nodules. The goal is to be able to diagnose all biologically significant cancers, while exposing the fewest number of patients with benign disease to unnecessary diagnostic testing. Sonography of the neck has emerged as the primary imaging means to evaluate the malignant potential of thyroid nodules. Although no single sonographic feature can be used to detect all cancerous nodules, some sonogr...

A comparative study of 200 head and neck FNAs performed by a cytopathologist with versus without ultrasound guidance: Evidence for improved diagnostic value with ultrasound guidance

Our previous study showed that the sensitivity of head and neck fine-needle aspiration (FNA) procedures was significantly better in the cytopathologist-performed group than in the noncytopathologist-performed group (96 versus 67%). Recently, cytopathologists have learned to use ultrasound machines to assist them in performing FNA procedures. This study was designed to assess whether cytopathologist-performed FNAs with ultrasound guidance can improve diagnostic value in comparison to those done without ultrasound guidance. Two hundred consecutive head and neck FNA cases performed by the same cytopathologist with and without ultrasound guidance were reviewed. Cases consisted of 100 ultrasound-guided FNAs (USGFNAs) performed between July 2008 and March 2009 and 100 palpation-guided FNAs (PGFNAs) performed before July 2008. These cases were correlated with follow-up surgical diagnosis. The diagnostic, suspicious/atypical/suggestive, and nondiagnostic rates (%) for the head and neck FNAs were 83 versus 86, 10 versus 13, and 7 versus 1 in PGFNA group versus USGFNA group, respectively. Surgical follow-up specimens were found in 50 PGFNAs versus 35 USGFNAs. The true-positive, true-negative, false-positive, and false-negative rates (%) were 92, 2, 2, and 4 versus 80, 17, 3, and 0 in PGFNAs versus USGFNAs, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 96, 50, 98, 33, and 94% in PGFNAs versus 100, 86, 97, 100, and 97% in the USGFNA group, respectively. This study also shows increased FNAs of thyroid and salivary glands and other smaller nonpalpable lesions with ultrasound guidance. USGFNAs performed by a cytopathologist could significantly improve the specificity and NPV (P = 0.04) while preserving virtually the same excellent sensitivity and PPV as those of PGFNAs. With ultrasound guidance, a cytopathologist will be able to perform FNAs in smaller, nonpalpable lesions and target complex lesions with confidence and accuracy, thus achieving a better outcome.

Diagnostic efficacy of surgeon-performed ultrasound-guided fine needle aspiration: A randomized controlled trial

Objective To evaluate the clinical efficacy of surgeon-performed, office-based head and neck ultrasound in facilitating diagnostic fine needle aspiration (FNA) of lesions in the head and neck. Study Design A randomized controlled trial of ultrasound-guided FNA versus traditional palpation-guided technique for palpable masses in the head and neck. Setting An office-based study performed in a military academic medical center. Subjects and Methods Eighty-one adults older than 18 years of age with a palpable head and neck mass (less than 3 cm in largest diameter) were randomized to ultrasound-guided or traditional palpation-guided FNA of a head and neck mass. Measured variables and outcomes for the study included tissue adequacy rates, tissue type, and operator variability. Results Following three passes using either palpation or ultrasound guidance, a comparative tissue adequacy rate of 84 percent for ultrasound guidance versus 58 percent for standard palpation was established ( P < 0.014). With regard to tissue type, a statistically significant comparative diagnostic advantage for ultrasound guidance was observed in thyroid tissue while remaining statistically insignificant for lymphatic and salivary tissues. No statistical significance was found when comparing the ability of otolaryngology residents versus attending otolaryngologists to obtain ultrasound-guided diagnostic samples. Conclusion Office-based surgeon-performed ultrasound-guided FNA of palpable lesions in the head and neck yields a statistically significant higher diagnostic rate compared to standard palpation technique. Our institutional experience supports the utility of surgeon-performed ultrasound as a core competency in clinical practice.

Ultrasonography in the Diagnosis and Follow-up of Nasopharyngeal Carcinoma

We present a case with an initial presentation of smooth nasopharyngeal mucosa and vague left upper neck swelling. Palpation-guided fine-needle aspiration was performed initially, but the specimen was inadequate and showed only blood. Ultrasound-guided fine-needle aspiration of the lymph node was conducted, and cytology suggested metastatic carcinoma. In addition, computed tomography with detailed endoscopic examination and biopsy of the nasopharynx finally confirmed nasopharyngeal carcinoma. Serial change of the malignant lymph node after irradiation was followed by ultra-sound and disappeared on the third month after radiotherapy. Our experiences with this case highlight the benefits of ultrasound-guided fine-needle aspiration for clinically vague neck masses, in avoiding unnecessary and harmful open biopsies in the diagnosis of nasopharyngeal carcinoma patients.

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

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.

Application of the Breast Imaging Reporting and Data System Final Assessment System in Sonography of Palpable Breast Lesions and Reconsideration of the Modified Triple Test

The purpose of our study was to evaluate the utility of the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) sonographic final assessment system and palpation-guided fine-needle aspiration (FNA) for evaluation of palpable breast lesions. Our computerized database identified 160 palpable lesions of the breast in which follow-up palpation-guided FNA, targeted sonography, and pathologic confirmation were performed. We used BI-RADS sonographic data on all lesions. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of malignancy were calculated for sonography and palpation-guided FNA. Two-sample binomial proportion tests were used as the statistical analysis (P<.05). The FNA results were defined as benign, atypical cells, suspicious for malignancy, malignancy, and insufficiency. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90.9%, 82.7%, 84.3%, 57.7%, and 97.2%, respectively, on sonography and 75.8% to 90.9%, 82.7% to 98.4%, 84.3% to 94.4%, 57.7% to 92.6%, and 93.9% to 97.2% on FNA. There was no statistically significant difference for sensitivity and negative predictive value between the two examinations. The diagnostic accuracy of sonography was similar to that of palpation-guided FNA for not missing the malignancy. Clinical application of FNA results can be difficult, especially when the result is insufficiency or atypical cells. Moreover, FNA is invasive and overlaps other procedures. Therefore, we conclude that sonography can replace palpation-guided FNA for diagnosis of palpable lesions of the breast when the BI-RADS sonographic final assessment system is used appropriately.

Comparison of Palpation-Guided Fine-Needle Aspiration Biopsy to Ultrasound-Guided Fine-Needle Aspiration Biopsy in the Evaluation of Thyroid Nodules

Although fine-needle aspiration biopsy (FNAB) of thyroid nodules is a reliable and simple method, the diagnostic value may be limited by inadequate and false-negative results. In this prospective study, we compared palpation-guided FNAB (PGFNAB) with ultrasound-guided FNAB (UGFNAB) to establish the rates of inadequate material and cost-effectiveness. A total of 285 thyroid nodules in 215 patients were included in the study. Palpable nodules with the greatest diameter between 1 and 2.5 cm were included in the study. PGFNAB and UGFNAB techniques were applied to the same nodule by the same operator. Cytologic evaluations were performed by the same cytologist in a blinded fashion. To provide cost analysis, the prices obtained from different hospitals were evaluated. The rates of inadequate material for PGFNAB and UGFNAB were significantly different as 32.3% and 21.4%, respectively (p = 0.004). There was significantly higher inadequate material rate in PGFNAB group for small-sized nodules (greatest nodule diameter between 10 and 15 mm) (p = 0.009), despite inadequate material rate was not significant for both procedures for larger sized nodules. False-negative results were 15.8% for PGFNAB and 5.6% for UGFNAB. Regarding cost analysis, the difference between the two methods was 20 dollars on average for each patient. We consider UGFNAB to be superior to PGFNAB for obtaining adequate material especially for small-sized nodules, as well as providing more accurate cytologic evaluation. Indeed, the difference between the costs of two procedures might be acceptable.