Introduction: The thyroid gland is arguably the fastest growing anatomic site for fine needle aspiration (FNA). With the increase of thyroid cases, a reevaluation of cytotechnologist screening quality metrics in terms of thyroid FNA is called for. We present our institutional cytotechnologist performance at screening for nuclear atypia by applying established quality metrics. Materials and Methods: Information on 8,814 consecutive thyroid cytopathology cases over a 10-year period was retrieved from computerized records. A subsample of cases categorized either as atypia of uncertain significance with nuclear atypia or suspicious for malignancy with features suspicious for papillary thyroid carcinoma. The cytotechnologist and cytopathologist diagnoses were compared using step discrepancies and Δ-ratios. Results: Overall discrepancy between the cytotechnologist and cytopathologist diagnoses existed in <10% of all thyroid cases. One-category discrepancies were the most common (7.8%), while two-category discrepancies were rare (0.5%). The one-category discrepancy rate correlated with cytotechnologist experience. One-category undercalls were twice as common as overcalls (5.3 vs. 2.5%, p < 0.0001). Conclusions: We identified a high level of quality in the screening for nuclear atypia in thyroid FNA. The one-category discrepancy rate is suited to tracking individual cytotechnologist performance, identifies outliers and appears to correlate with cytotechnologist experience.

Keywords:
Thyroid gland, Fine needle aspiration, Nuclear atypia, Papillary thyroid carcinoma, Cytotechnologist screening
1.
Olson MT, Ali SZ: Cytotechnologist on-site evaluation of pancreas fine needle aspiration adequacy: comparison with cytopathologists and correlation with the final interpretation. Acta Cytol 2012;56:340-346.
2.
Olson MT, Novak A, Kirby J, Shahid H, Boonyaarunnate T, Ali SZ: Cytotechnologist-attended on-site evaluation of adequacy for metastatic disease involving bone and soft tissue. Acta Cytol 2013;57:550-556.
3.
Olson MT, Tatsas AD, Ali SZ: Cytotechnologist-attended on-site adequacy evaluation of thyroid fine-needle aspiration: comparison with cytopathologists and correlation with the final interpretation. Am J Clin Pathol 2012;138:90-95.
4.
Goulart RA: Cytotechnologists today: much more than ‘pap-ologists' with schools in need of our support. Am J Clin Pathol 2008;129:523-524.
5.
Cibas ES, Dean B, Maffeo N, Allred EN: Quality assurance in gynecologic cytology. The value of cytotechnologist-cytopathologist discrepancy logs. Am J Clin Pathol 2001;115:512-516.
6.
Clary KM, Davey DD, Naryshkin S, Austin RM, Thomas N, Chmara BA, Sugrue C, Tworek J: The role of monitoring interpretive rates, concordance between cytotechnologist and pathologist interpretations before sign-out, and turnaround time in gynecologic cytology quality assurance: findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference Working Group 1. Arch Pathol Lab Med 2013;137:164-174.
7.
Services UDoHaH: Medicare, Medicaid and CLIA programs: regulations implementing the Clinical Laboratory Improvement Amendments of 1988 (CLIA). Final rule. Fed Regist 1992;57:7002-7186.
8.
Cibas ES, Ali SZ: The Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 2009;132:658-665.
9.
Solomon D, Nayar R: The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes, ed 2. New York, Springer, 2006.
10.
Olson MT, Boonyaarunnate T, Aragon Han P, Umbricht CB, Ali SZ, Zeiger MA: A tertiary center's experience with second review of 3885 thyroid cytopathology specimens. J Clin Endocrinol Metab 2013;98:1450-1457.
11.
Sherman ME, Dasgupta A, Schiffman M, Nayar R, Solomon D: The Bethesda Interobserver Reproducibility Study (BIRST): a web-based assessment of the Bethesda 2001 System for Classifying Cervical Cytology. Cancer 2007;111:15-25.
12.
Olson MT, Clark DP, Erozan YS, Ali SZ: Spectrum of risk of malignancy in subcategories of ‘atypia of undetermined significance'. Acta Cytol 2011;55:518-525.
13.
Krieger P, Naryshkin S: Random rescreening of cytologic smears: a practical and effective component of quality assurance programs in both large and small cytology laboratories. Acta Cytol 1994;38:291-298.
14.
Krieger PA, Cohen T, Naryshkin S: A practical guide to Papanicolaou smear rescreens: how many slides must be reevaluated to make a statistically valid assessment of screening performance? Cancer 1998;84:130-137.
15.
Davey DD, Woodhouse S, Styer P, Stastny J, Mody D: Atypical epithelial cells and specimen adequacy: current laboratory practices of participants in the College of American Pathologists interlaboratory comparison program in cervicovaginal cytology. Arch Pathol Lab Med 2000;124:203-211.
16.
Juskevicius R, Zou KH, Cibas ES: An analysis of factors that influence the ASCUS/SIL ratio of pathologists. Am J Clin Pathol 2001;116:331-335.
17.
Nascimento AF, Cibas ES: The ASC/SIL ratio for cytopathologists as a quality control measure: a follow-up study. Am J Clin Pathol 2007;128:653-656.
18.
Whigham P, Ilario MJ, Flanagan MB, Mauser N, Raab SS, Ohori NP: Discrepancy analysis, communication, and feedback for cytotechnologist quality improvement of nongynecologic cytopathology. Diagn Cytopathol 2006;34:265-269.
19.
Gill GW: Monitoring cytotechnologist-cytopathologist discrepancy in nongynecologic cytopathology. Diagn Cytopathol 2006;34:270-271.
20.
Krane JF, Vanderlaan PA, Faquin WC, Renshaw AA: The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio: a proposed performance measure for reporting in the Bethesda System for thyroid cytopathology. Cancer Cytopathol 2012;120:111-116.
21.
Kleiman DA, Sporn MJ, Beninato T, Crowley MJ, Nguyen A, Uccelli A, Scognamiglio T, Zarnegar R, Fahey TJ 3rd: Preoperative BRAF(V600E) mutation screening is unlikely to alter initial surgical treatment of patients with indeterminate thyroid nodules: a prospective case series of 960 patients. Cancer 2013;119:1495-1502.
22.
Wang CC, Friedman L, Kennedy GC, Wang H, Kebebew E, Steward DL, Zeiger MA, Westra WH, Wang Y, Khanafshar E, Fellegara G, Rosai J, Livolsi V, Lanman RB: A large multicenter correlation study of thyroid nodule cytopathology and histopathology. Thyroid 2011;21:243-251.
© 2014 S. Karger AG, Basel
2014
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