University of Massachusetts Medical School Faculty Publications

Title

Performance differences between conventional smears and liquid-based preparations of thyroid fine-needle aspiration samples: analysis of 47,076 responses in the College of American Pathologists Interlaboratory Comparison Program in Non-Gynecologic Cytology

UMMS Affiliation

Department of Pathology

Publication Date

2013-1

Document Type

Article

Subjects

Biopsy, Fine-Needle; Carcinoma, Papillary; Diagnostic Errors; Goiter; Humans; Pathology, Surgical; Societies, Medical; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms; United States

Disciplines

Diagnosis | Pathology

Abstract

CONTEXT: Controversy exists about whether thyroid fine-needle aspirates (FNAs) should be processed with conventional smears or liquid-based preparations (LBPs).

OBJECTIVE: To compare the performance of conventional smears to LBPs for thyroid FNA slides circulated in the College of American Pathologists Interlaboratory Comparison Program in Non-Gynecologic Cytology.

DESIGN: Participant responses for thyroid FNA slides were compared with the reference diagnosis at the level of 3 general diagnostic categories: negative, suspicious (which included only follicular and Hurthle cell neoplasm), and malignant. For specific reference diagnoses of benign/goiter and papillary thyroid carcinoma, the participants' specific diagnoses were analyzed and poorly performing slides were rereviewed.

RESULTS: The 47, 076 thyroid FNA slide responses, between 2001 and 2009, included 44, 478 responses (94%) for conventional smears and 2598 responses (6%) for LBPs. For the general reference category negative, participant responses were discrepant in 14.9% of conventional smears compared with 5.9% for LBPs (P < .001). The specific reference diagnosis of benign/goiter was misdiagnosed as a follicular neoplasm in 7.8% of conventional smears, compared with 1.3% of LBP. For the general reference category of malignant, participant responses were discrepant in 7.3% of conventional smears compared with 14.7% of LBPs (P < .001). The specific reference diagnosis of papillary thyroid carcinoma was misdiagnosed as benign/goiter in 7.2% of LBPs, compared with 4.8% of conventional smears (p <.001).

CONCLUSIONS: LBPs performed worse than conventional smears for cases with a reference diagnosis of papillary thyroid carcinoma. However, LBPs performed better than conventional smears for cases with a benign reference diagnosis. Specific features in thyroid FNAs that may improve the diagnostic accuracy of LBPs and conventional smears are described.

DOI of Published Version

10.5858/arpa.2012-0009-CP

Source

Andrew H. Fischer, Amy C. Clayton, Joel S. Bentz, Patricia G. Wasserman, Michael R. Henry, Rhona J. Souers, and Ann T. Moriarty (2013) Performance Differences Between Conventional Smears and Liquid-Based Preparations of Thyroid Fine-Needle Aspiration Samples: Analysis of 47 076 Responses in the College of American Pathologists Interlaboratory Comparison Program in Non-Gynecologic Cytology. Archives of Pathology & Laboratory Medicine: January 2013, Vol. 137, No. 1, pp. 26-31. doi: 10.5858/arpa.2012-0009-CP. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Archives of pathology and laboratory medicine

PubMed ID

23276172

Share

COinS