1. The Frequency of ‘Atypia of Undetermined Significance’ Interpretations for Thyroid Fine-Needle Aspirations Is Negatively Correlated with Histologically Proven Malignant Outcomes
- Author
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Paul A. VanderLaan, Jeffrey F. Krane, and Edmund S. Cibas
- Subjects
Risk ,medicine.medical_specialty ,Histology ,Biopsy, Fine-Needle ,Thyroid Gland ,Malignancy ,Pathology and Forensic Medicine ,Tertiary Care Centers ,Terminology as Topic ,Atypia ,medicine ,Humans ,Thyroid Nodule ,False Negative Reactions ,Retrospective Studies ,Thyroid.FNA ,Gynecology ,Retrospective review ,medicine.diagnostic_test ,business.industry ,Thyroid ,General Medicine ,Prognosis ,medicine.disease ,Cell Transformation, Neoplastic ,medicine.anatomical_structure ,Fine-needle aspiration ,Cytopathology ,Practice Guidelines as Topic ,Cohort ,Radiology ,business - Abstract
Objective: Cytopathologists’ usage patterns for ‘atypia of undetermined significance’ (AUS) in thyroid fine-needle aspiration (FNA) are not well understood. AUS rates over a 5-year period were analyzed to quantify variability and identify correlations with experience and histologic outcomes. Study Design: A retrospective review of thyroid FNAs from a tertiary-care hospital from 2005 to 2009 was performed. Results were compiled for individual cytopathologists, stratified by year, and correlated with histologic outcomes. Results: Thyroid FNAs (5,327) were evaluated by 7 cytopathologists, with an overall AUS rate of 11.2%. The annual AUS rate remained relatively constant over this time period, though notable inter- and intrapathologist variability was seen. The AUS rate was significantly lower for those with cytopathology boards (10.3%) compared to those without (14.0%). There was no correlation between the AUS rate and cytopathologist experience or thyroid FNA volume. The AUS rate and malignant outcome were inversely related: the higher an individual’s AUS rate was, the lower the rate of malignancy for that AUS cohort was. Conclusions: Individual cytopathologist AUS rates were variable and often exceeded the recommended target of 7%. The application of recently published defined diagnostic criteria, along with directed cytopathologist feedback, may reduce observer variability and appropriately lower AUS utilization.
- Published
- 2011