Abstract
Objectives:Ultrasound-guided fine needle aspiration cytology (US-FNAC) represents the most effective test available to distinguish between benign and malignant thyroid nodules. The major limit is the rate of inadequate specimens which generates a much higher cost. The aim of the present study was to evaluate whether the adoption of stylet needles may result in a significant improvement of diagnostic performance in a large, unselected series of nodules.Methods:1468 nodules were submitted to US-FNAC by two different 25-gauge needles: a traditional hollow needle (Ns) or a stylet needle (Ys). Cytological specimens were evaluated in blind conditions by the same cytopathologist.Results:Ys was associated to a significant reduction of non-diagnostic specimens (2.8% vs 9.1% by Ns, respectively, P < 0.001). Logistic regression analysis taking into account sex, age, needle type, nodule size, multiplicity and structure predictor of successful sampling [odds ratio 3.6 (95.0% CN 2.0–6.4), P < 0.001]. The cost analysis comparing the adoption of the two types of needle evidenced that the cost per adequate specimen was consistently less for Ys than for Ns (&OV0556; 78.87 vs &OV0556; 90.76).Conclusion:Our data showed that the adoption of a stylet needle significantly improves diagnostic performance, reducing by about 14% the expenditure per diagnostic procedure. Therefore, we suggest that stylet needles should be widely adopted to perform US-FNAC of thyroid procedures.
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References
References1. Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351:1764–1771.HegedüsLClinical practice. The thyroid nodule.N Engl J Med20043511764-17712. Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med 1993;118:282–289.GharibH]]GoellnerJRFine-needle aspiration biopsy of the thyroid: an appraisal.Ann Intern Med1993118282-2893. Suen KC. Fine-needle aspiration biopsy of the thyroid. CMAJ 2002;167:491–495.SuenKCFine-needle aspiration biopsy of the thyroid.CMAJ2002167491-4954. Söoderströom N. Puncture of goiters for aspiration biopsy. Acta Med Scand 1952;144:237–244.SöoderströomNPuncture of goiters for aspiration biopsy.Acta Med Scand1952144237-2445. Crockford PM, Brain GO. Fine-needle aspiration of the thyroid. Can Med Assoc J 1974;110:1029–1032.CrockfordPM]]BrainGOFine-needle aspiration of the thyroid.Can Med Assoc J19741101029-10326. Walfish PG, Miskin M, Rosen IB, et al. Application of special diagnostic techniques in the management of nodular goitre. Can Med Assoc J 1976;115:35–40.WalfishPG]]MiskinM]]RosenIB&etal;Application of special diagnostic techniques in the management of nodular goitre.Can Med Assoc J197611535-407. Gershengorn MC, McClung MR, Chu EW, et al. Fine-needle aspiration cytology in the preoperative diagnosis of thyroid nodules. Ann Intern Med 1977;87:265–269.GershengornMC]]McClungMR]]ChuEW&etal;Fine-needle aspiration cytology in the preoperative diagnosis of thyroid nodules.Ann Intern Med197787265-2698. Wang HH. Reporting thyroid fine-needle aspiration: literature review and a proposal. Diagn Cytopathol 2006;34:67–76.WangHHReporting thyroid fine-needle aspiration: literature review and a proposal.Diagn Cytopathol20063467-769. Giuffrida D, Gharib H. Controversies in the management of cold, hot, and occult thyroid nodules. Am J Med 1995;99:642–650.GiuffridaD]]GharibHControversies in the management of cold, hot, and occult thyroid nodules.Am J Med199599642-65010. Caruso D, Mazzaferri EL. Fine needle aspiration biopsy in the management of thyroid nodules. Endocrinologist 1991;1:194–202.CarusoD]]MazzaferriELFine needle aspiration biopsy in the management of thyroid nodules.Endocrinologist19911194-20211. Hall TL, Layfield LJ, Philippe A, et al. Sources of diagnostic error in fine needle aspiration of the thyroid. Cancer 1989;63:718–725.HallTL]]LayfieldLJ]]PhilippeA&etal;Sources of diagnostic error in fine needle aspiration of the thyroid.Cancer198963718-72512. Degirmenci B, Haktanir A, Albayrak R, et al. Sonographically guided fine-nedle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytological material. Clin Radiol 2007;62:798–803.DegirmenciB]]HaktanirA]]AlbayrakR&etal;Sonographically guided fine-nedle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytological material.Clin Radiol200762798-80313. Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005;237:794–800.FratesMC]]BensonCB]]CharboneauJW&etal;Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement.Radiology2005237794-80014. Borget I, Vielh P, Leboulleux S, et al. Assessment of the cost of fine-needle aspiration cytology as a diagnostic tool in patients with thyroid nodules. Am J Clin Pathol 2008;129:763–771.BorgetI]]VielhP]]LeboulleuxS&etal;Assessment of the cost of fine-needle aspiration cytology as a diagnostic tool in patients with thyroid nodules.Am J Clin Pathol2008129763-77115. Carpi A, Di Coscio G, Iervasi G, et al. Thyroid fine needle aspiration: how to improve clinicians' confidence and performance with the technique. Cancer Lett 2008;264:163–171.CarpiA]]Di CoscioG]]IervasiG&etal;Thyroid fine needle aspiration: how to improve clinicians' confidence and performance with the technique.Cancer Lett2008264163-17116. Cappelli C, Tironi A, Mattanza C, et al. Cost-effectivness of fine needle aspiration cytology of thyroid nodules with intranodular vascular pattern using two different needle types. Endocr Pathol 2005;16:349–354.CappelliC]]TironiA]]MattanzaC&etal;Cost-effectivness of fine needle aspiration cytology of thyroid nodules with intranodular vascular pattern using two different needle types.Endocr Pathol200516349-35417. Cappelli C, Pirola I, Castellano M, et al. Fine needle cytology of complex thyroid nodules. Eur J Endocrinol 2007;157:529–532.CappelliC]]PirolaI]]CastellanoM&etal;Fine needle cytology of complex thyroid nodules.Eur J Endocrinol2007157529-53218. Cappelli C, Tironi A, Pirola I, et al. Spinal needle improves diagnostic cytological specimens of thyroid nodules. J Endocrinol Invest 2008;31:25–28.CappelliC]]TironiA]]PirolaI&etal;Spinal needle improves diagnostic cytological specimens of thyroid nodules.J Endocrinol Invest20083125-2819. Martin HE, Ellis EB. Biopsy by needle puncture and aspiration. Ann Surg 1930;92:169–181.MartinHE]]EllisEBBiopsy by needle puncture and aspiration.Ann Surg193092169-18120. Zhu W, Michael CW. How important is on-site adequacy assessment for thyroid FNA? An evaluation of 883 cases. Diagn Cytopathol 2007;35:183–186.ZhuW]]MichaelCWHow important is on-site adequacy assessment for thyroid FNA? An evaluation of 883 cases.Diagn Cytopathol200735183-18621. Castro MR, Gharib H. Continuing controversies in the management of thyroid nodules. Ann Intern Med 2005;142:926–931.CastroMR]]GharibHContinuing controversies in the management of thyroid nodules.Ann Intern Med2005142926-93122. Nguyen GK, Lee MW, Ginsberg J, et al. Fine-needle aspiration of the thyroid: an overview. Cytojournal 2005;2:12.NguyenGK]]LeeMW]]GinsbergJ&etal;Fine-needle aspiration of the thyroid: an overview.Cytojournal200521223. Redman R, Zalaznick H, Mazzaferri EL, et al. The impact of assessing specimen adequacy and number of needle passes for fine-needle aspiration biopsy of thyroid nodules. Thyroid 2006;16:55–60.RedmanR]]ZalaznickH]]MazzaferriEL&etal;The impact of assessing specimen adequacy and number of needle passes for fine-needle aspiration biopsy of thyroid nodules.Thyroid20061655-6024. Cai XJ, Valiyaparambath N, Nixon P, et al. Ultrasound-guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules. Cytopathology 2006;17:251–256.CaiXJ]]ValiyaparambathN]]NixonP&etal;Ultrasound-guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules.Cytopathology200617251-25625. Bajaj Y, De M, Thomson A. Fine needle aspiration cytology in diagnosis and management of thyroid disease. J Laryngol Otol 2006;120:467–469.BajajY]]DeM]]ThomsonAFine needle aspiration cytology in diagnosis and management of thyroid disease.J Laryngol Otol2006120467-46926. Alexander EK, Heering JP, Benson CB, et al. Assessment of non-diagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab 2002;87:4924–4927.AlexanderEK]]HeeringJP]]BensonCB&etal;Assessment of non-diagnostic ultrasound-guided fine needle aspirations of thyroid nodules.J Clin Endocrinol Metab2002874924-492727. Izquierdo R, Arekat MR, Knudson PE, et al. Comparison of palpation-guided versus ultrasound-guided fine-needle aspiration biopsies of thyroid nodules in an outpatient endocrinology practice. Endocr Pract 2006;12:609–614.IzquierdoR]]ArekatMR]]KnudsonPE&etal;Comparison of palpation-guided versus ultrasound-guided fine-needle aspiration biopsies of thyroid nodules in an outpatient endocrinology practice.Endocr Pract200612609-61428. Pothier DD, Narula AA. Should we apply suction during fine needle cytology of thyroid lesions? A systematic review and meta-analysis. Ann R Coll Surg Engl 2006;88:643–645.PothierDD]]NarulaAAShould we apply suction during fine needle cytology of thyroid lesions? A systematic review and meta-analysis.Ann R Coll Surg Engl200688643-64529. Santos JE, Leiman G. Nonapiration fine needle cytology. Application of a new technique to nodular thyroid disease. Acta Cytol 1988;32:353–356.SantosJE]]LeimanGNonapiration fine needle cytology. Application of a new technique to nodular thyroid disease.Acta Cytol198832353-35630. Löwhagen T, Granberg PO, Lundell G, et al. Aspiration biopsy cytology (ABC) in nodules of the thyroid gland suspected to be malignant. Surg Clin North Am 1979;59:3–18.LöwhagenT]]GranbergPO]]LundellG&etal;Aspiration biopsy cytology (ABC) in nodules of the thyroid gland suspected to be malignant.Surg Clin North Am1979593-1831. Mair S, Dunbar F, Becker PJ, et al. Fine needle cytology aspiration suction is necessary? A study of 100 masses in various sites. Acta Cytol 1989;33:809–813.MairS]]DunbarF]]BeckerPJ&etal;Fine needle cytology aspiration suction is necessary? A study of 100 masses in various sites.Acta Cytol198933809-81332. Tublin ME, Martin JA, Rollin LJ, et al. Ultrasound-guided fine-needle aspiration versus fine-needle capillary sampling biopsy of thyroid nodules: does technique matter? J Ultrasound Med 2007;26:1697–1701.TublinME]]MartinJA]]RollinLJ&etal;Ultrasound-guided fine-needle aspiration versus fine-needle capillary sampling biopsy of thyroid nodules: does technique matter?J Ultrasound Med2007261697-170133. O'Malley ME, Weir MM, Hahn PF, et al. US-guided fine-needle aspiration biopsy of thyroid nodules: adequacy of cytologic material and procedure time with and without immediate cytologic analysis. Radiology 2002;222:383–387.O'MalleyME]]WeirMM]]HahnPF&etal;US-guided fine-needle aspiration biopsy of thyroid nodules: adequacy of cytologic material and procedure time with and without immediate cytologic analysis.Radiology2002222383-387
