Sources of diagnostic error in fine needle aspiration of the thyroid

Smears obtained from 795 patients with suspicious thyroid nodules by fine needle aspiration (FNA) of the thyroid gland were seen over a 5‐year period at the UCLA Center for the Health Sciences. From 72 patients who underwent subsequent surgical excision of their nodules, inadequate or discrepant FNA...

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Bibliographic Details
Published inCancer Vol. 63; no. 4; pp. 718 - 725
Main Authors Hall, Thomas L., Layfield, Lester J., Philippe, Anne, Rosenthal, Dorothy L.
Format Journal Article
LanguageEnglish
Published New York Wiley Subscription Services, Inc., A Wiley Company 15.02.1989
Wiley-Liss
Subjects
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Biopsy, Needle
Diagnostic Errors
Endocrinopathies
Humans
Medical sciences
Middle Aged
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Predictive Value of Tests
Retrospective Studies
Thyroid Diseases - pathology
Thyroid Neoplasms - pathology
Thyroid. Thyroid axis (diseases)
Endocrinopathy
Performance evaluation
Human
Pathology
Fine needle
Thyroid diseases
Error
Diagnosis
Technique
Aspiration punction
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Summary:Smears obtained from 795 patients with suspicious thyroid nodules by fine needle aspiration (FNA) of the thyroid gland were seen over a 5‐year period at the UCLA Center for the Health Sciences. From 72 patients who underwent subsequent surgical excision of their nodules, inadequate or discrepant FNA diagnoses were noticed in 20 cases (27.8%). These errors could be attributed to inadequate material for diagnosis (n = 6), sampling errors (n = 2), and cytodiagnostic errors (n = 12). If the diagnosis of follicular neoplasm was treated as indeterminate for malignancy, the overall efficiency of FNA was 88.9%. All false‐negative diagnoses were related to procedure (i.e., inadequate smears or missed sampling of the lesion). The frequency of inadequate smears, in turn, was strongly related to the type of physician performing the aspiration. The frequency was highest among community‐based clinicians (32.4%) and lowest among hospital‐based cytopathologists (6.4%). With adequate sampling, the finding of 100% sensitivity in the diagnosis of malignant neoplasms by FNA cytology reaffirms its role as the procedure of choice in the initial screening of thyroid nodules.
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ISSN:0008-543X
1097-0142
DOI:10.1002/1097-0142(19890215)63:4<718::AID-CNCR2820630420>3.0.CO;2-N