RESUMO
INTRODUCTION: Cytologic rapid on-site evaluation (ROSE) during minimally invasive biopsy procedures is an increasingly important service provided by cytopathology to increase diagnostic yield and appropriately triage cellular material. Although ROSE can be performed by cytopathologists, cytotechnologists, or cytopathology fellows, few studies have directly compared both procedural and diagnostic outcome measures among different ROSE personnel. MATERIALS AND METHODS: We evaluated all transthoracic computed tomography (CT)-guided lung biopsies in which ROSE was performed during a 1-year period at 2 academic institutions with similar patient populations and procedural methods: Dartmouth-Hitchcock Medical Center (DHMC) (where ROSE is performed by cytopathologists) and the Beth Israel Deaconess Medical Center (BIDMC) (where ROSE is rendered by either cytotechnologists or cytopathology fellows). RESULTS: A total of 273 CT-guided transthoracic lung biopsies (190 DHMC, 83 BIDMC) were analyzed. There was no major difference in procedure time with respect to ROSE personnel. The repeat procedure rate for nondiagnostic biopsies was similar at DHMC (cytopathologists) and BIDMC (cytotechnologists or cytology fellows) (2.1% versus 2.3%, P = 1.0). Adequacy rates for cytopathologists, cytotechnologists, and cytopathology fellows were comparable (P = 0.23). ROSE assessments by cytopathologists were more concordant with the final diagnosis (87%) than those by cytotechnologists (82%) or cytopathology fellows (79%); this difference was not statistically significant (P = 0.28). CONCLUSIONS: ROSE procedural and diagnostic outcomes for transthoracic CT-guided lung biopsies were similar among cytopathologists, cytotechnologists, and cytopathology fellows.
RESUMO
BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology was published in 2008 and was implemented at Beth Israel Deaconess Medical Center (BIDMC) in June, 2010. Prior to this date, our diagnostic scheme was similar to the Bethesda System, except for the category of "Atypia/Follicular Lesion of Undetermined Significance" (AUS). This study evaluates the impact of the Bethesda System on the rate and the positive predictive value (PPV) of the diagnostic categories at BIDMC. METHODS: We performed a retrospective review of all thyroid fine-needle aspirations (FNAs) during the time periods January, 2006 to November, 2008 and June, 2010 to July, 2011 and the subsequent thyroidectomy specimens. RESULTS: Post-Bethesda System, diagnoses that are equivocal for diverse reasons and which have wide-ranging PPVs are now all grouped into the AUS category, and the proportion of cases that are in the atypical/AUS category rose from 3.7% in the pre-Bethesda period to 12% in the post-Bethesda period. CONCLUSION: The AUS category has a PPV approaching 50% in our lab. This creates uncertainty regarding the appropriate management for this category and may cause unnecessary overuse of molecular testing for cases in the AUS category.