Predictors of Non-diagnostic Cytology in Surgeon-Performed ... · PDF file Ultrasound-guided...

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Transcript of Predictors of Non-diagnostic Cytology in Surgeon-Performed ... · PDF file Ultrasound-guided...

  • • Retrospective chart review • Setting: tertiary Otolaryngology – Head & Neck Surgery

    referral center • Patients: adults who underwent ultrasound-guided

    fine needle aspiration biopsy of one or more thyroid nodules at the University of Alberta Hospital Division of Otolaryngology between January 2011 and December 2013

    • Cytopathological interpretation: Bethesda System18

    FACTORS EXAMINED: • Patient/demographic factors • Thyroid factors • Nodule factors • Surgeon factors

    • Adult patients • Diagnostic thyroid ultrasound with nodules • Underwent ultrasound-guided FNA by

    Otolaryngology staff, fellow, or resident • Lost/improperly processed aspirates • Pathology not available • Ultrasound report not available

    • DATA ANALYSIS: • Chi-squared for categorical data • T-tests for numerical data • Multivariate binomial logistic regression analysis

    Predictors of Non-diagnostic Cytology in Surgeon-Performed

    Ultrasound Guided FNA of Thyroid Nodules Andre Isaac1, Caroline Jeffery1, Hadi Seikaly1, Hani Al-Marzouki1, Jeff Harris1, Dan O’Connell1

    1Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB




    Thyroid nodules are extremely common, with 7% of adult patients demonstrating clinically palpable nodules,1 and up to 70% have nodules on ultrasound.2 Fine needle aspiration (FNA) is the standard of care diagnostic tool for thyroid nodule work-up3-5 Surgeon-performed FNA is safe, cost-effective, and has become widely accepted.6-8 It also has the added benefit of decreasing wait time to surgery. The FNA non-diagnostic rate ranges from 6-36%.9-15 A non-diagnostic FNA results in repeated procedures, multiple specialist visits, delay to treatment, and worsened patient outcomes.16 Some studies have examined factors that may influence the FNA diagnostic rate in non-surgeons,10-11,17 including size < 0.5cm, and predominant cystic component.9-15 No studies have examined this in surgeon-performed FNA. If the non- diagnostic rate and predictors are different for surgeons, particular patients may benefit from early surgeon referral.

    Objective: To determine the rate and factors that are predictive of non-diagnostic cytology in surgeon-performed ultrasound guided FNA of thyroid nodules


    Andre Isaac,


    Division of Otolaryngology-

    Head and Neck Surgery

    University of Alberta

    Variable Diagnostic Non-

    diagnostic p-value

    Thyroid Dimensions

    Enlarged 29% 33% 0.66

    Not Enlarged 71% 67%

    Palpable 77% 64% 0.07

    Nodule size

    Average 23(+/-13)mm 19(+/-15)mm 0.25

    >4cm 10% 8% 0.8