Pathologist Case Volume Affects Thyroid FNA Reading

But clinicians' case volume does not influence thyroid fine needle aspiration's diagnostic yield

MONDAY, Nov. 28 (HealthDay News) -- Case volume significantly affects pathologic interpretation of thyroid fine needle aspiration (FNA), but does not impact diagnostic yield, according to a study published in the November issue of the Archives of Otolaryngology -- Head & Neck Surgery.

Jeffrey J. Houlton, M.D., from the University of Cincinnati Academic Health Center, and colleagues investigated whether case volume influences the diagnostic yield and interpretation of thyroid FNA. Data from 790 patients, who underwent thyroid FNA at a tertiary referral center or one of two community hospital centers in 2009, were reviewed retrospectively. Differences in diagnostic distribution and yield were assessed among low- and high-case volume pathologists (16) and clinicians (134).

The investigators found that biopsy results were interpreted as benign, atypical, malignant, and nondiagnostic in 60, 22, 1, and 17 percent of cases, respectively. Compared to high-volume pathologists (≥50 FNAs), and compared with the expected normative data, low-volume pathologists (<50 FNAs) were significantly more likely to report FNAs as atypical and significantly less likely to report FNAs as benign (32 versus 13 percent and 50 versus 70 percent, respectively). Compared to atypical FNA findings reported by high-volume pathologists, those reported by low-volume pathologists were more likely to have benign permanent results (64 versus 42 percent). The likelihood of nondiagnostic thyroid FNAs being performed was similar for low-volume clinicians (<20 FNAs) and high-volume clinicians (≥20 FNAs) (16 and 15 percent, respectively; P = 0.47).

"Case volume significantly influences the pathologic interpretation of thyroid FNA," the authors write. "Case volume did not have a significant impact on diagnostic yield."

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