Surgeon-performed ultrasound-guided FNAC with on-site cytopathology improves adequacy and accuracy.

OBJECTIVE: To demonstrate that surgeon-performed fine-needle aspiration cytology (FNAC) results in a high percent of satisfactory FNAC results; the number of passes to obtain a satisfactory cytological result with on-site cytopathological interpretation is reduced with ultrasound guidance (comparing FNAC with and without surgeon-performed ultrasound guidance); and immediate triage for indeterminate thyroid nodules can be performed in one setting for molecular testing, potentially improving selection for surgery.

STUDY DESIGN: Retrospective cohort comparison.

METHODS: A cytopathologist is present for on-site staining adequacy evaluation and molecular testing triage for indeterminate cytology. Overall cytological adequacy and number of passes required to obtain cytological adequacy for 200 consecutive patients are compared with a historical series of 100 consecutive patients from the same surgeon and cytopathologists without ultrasound guidance.

RESULTS: The percent of patients with an adequate FNAC with ultrasound guidance was 100%. The mean number of passes with and without ultrasound guidance was 1.7 and 4.0 (P < 0.001). Indeterminate FNACs (9%) were triaged to molecular alteration testing and gene expression classifier testing.

CONCLUSIONS: Surgeon-performed ultrasound-guided FNAC with an experienced cytopathologist present resulted in a cytologically adequate result in 100% of cases. Significantly fewer passes for a satisfactory result were achieved with ultrasound guidance. Indeterminate FNAC can be triaged for molecular testing in one patient visit, was required in only 9% of carefully selected patients, and improved patient selection for surgery. The percent of patients who went on to surgery was 24 of 200 (12%). The percent of patients who had malignancy was 18 of 24 (75%).