Ultrasound Guided FNAC for Evaluation of Neck Lumps to Improve Inadequacy Rates; A Complete Audit Cycle
Keywords:Thyroid, aspiration, cytology, ultrasound, neck lump.
We present a completed audit cycle evaluating inadequacy rates in neck lump and thyroid fine needle aspiration cytology with and without ultrasound scan guidance.
The first cycle of the audit was from January to July 2010 comparing free hand fine needle aspiration cytology (FNAC) with ultrasound guided fine needle aspiration cytology (USS+FNAC). Changes to practice were made, firstly all thyroid FNAC would be performed with USS+FNAC and a reduced threshold for referral for USS+FNAC for non-thyroid neck masses. The second audit cycle was completed sixteen months later to assess for an improvement in practice. 1st phase; 155 patients, 70 freehand, 85 USS+FNAC. 50% of the thyroid FNAC freehand were inadequate compared to 18% of the thyroid USS+FNAC. 2nd phase; 196 patients, USS+FNAC 134, freehand 62. Thyroid FNAC 105 (USS+FNAC-104, freehand-1). Inadequate USS+FNAC = 21/104 (20%). The completed audit cycle shows an increased proportion of thyroid FNACs performed by ultrasound guidance, improving from 82% to 99%, with an overall reduction of inadequate thyroid FNACs from 24% to 21%. There was a noticeable variability in the inadequacy rates from radiologist to radiologist with the head and neck senior radiologist demonstrating the lowest inadequacy rate at 9.6% in the second cycle. Although ultrasound guidance for FNAC is important for the reasons of increased sensitivity, specificity and accuracy, we have demonstrated that the operator experience and skill are just as important.
Can AS, Peker K. Comparison of palpation-versus ultrasound-guided fine-needle aspiration biopsies in the evaluation of thyroid nodules. BMC Res Notes 2008; 1: 12. http://dx.doi.org/10.1186/1756-0500-1-12
Cooper DS. Doherty GM. Haugen BR. Kloos RT. Lee SL. Mandel SJ, et al. Revised American thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer, November 2009. Thyroid 2009; 19(11): 1167-14. http://dx.doi.org/10.1089/thy.2009.0110
Roland NJ, Paleri V, Eds. Head and Neck Cancer: Multidisciplinary Management Guidelines. 4th ed. London: ENT UK 2011.
De Meer SGA, Schreinemakers JMJ, Zelissen PMJ, Stapper G, Sie-Go DMDS, Rinkes IHMB, et al. Fine-needle aspiration of thyroid tumors: Identifying factors associated with adequacy rate in a large academic center in the Netherlands. Diagn Cytopathol 2012; 40(Suppl 1): E21-6. http://dx.doi.org/10.1002/dc.21521
Nguyen G, Lee M, Ginsberg J, Wragg T, Bioldeau D. Fine needle aspiration of the thyroid: An overview. Cytojournal 2005; 2(12): 1-13.
Oertel YC. Fine-needle aspiration of the thyroid: technique and terminology. Endocrinol Metab Clin North Am 2007; 36: 737-51. http://dx.doi.org/10.1016/j.ecl.2007.05.001
Can AS. Cost-effectiveness comparison between palpation- and ultrasound-guided thyroid fine-needle aspiration biopsies. BMC Endocr Disord 2009; 9-14.
Marqusee E, Benson CB, Frates MC, Doubilet PM, Larsen PR, Cibas ES, et al. Utility of ultrasound in the management of nodular thyroid disease. Ann Intern Med 2000; 133: 696-700.
Ganguly A. Giles TE, Smith PA, White FE, Nixon PP. The benefits of on-site cytology with ultrasound-guided fine needle aspiration in a one-stop neck lump clinic. Ann R Coll Surg Engl 2010; 92: 660-64. http://dx.doi.org/10.1308/003588410X12699663905032
Witcher TP, Williams MD. “One-stop” clinics in the investigation and diagnosis of head an neck lumps. Br J Oral Maxillofac Surg 2007; 45: 19-22. http://dx.doi.org/10.1016/j.bjoms.2006.03.018
National Institute for Health Care and Excellence. Guidance on cancer services: Improving outcomes in head and neck cancers. London: Nice 2004.
Robitschek J, Straub M, Wirtz E, Klem C, Sniezek J. Diagnostic efficacy of surgeon-performed ultrasound-guided fine needle aspiration: a randomized controlled trial. Otolaryngol Head Neck Surg 2010; 142: 303-64. http://dx.doi.org/10.1016/j.otohns.2009.11.011