Non-diagnostic samples following ultrasound-guided fine needle aspiration biopsy (FNAB) of suspicious thyroid nodules is a common problem faced by radiologists (1, 2). Non-diagnostic samples have the potential to increase time to diagnosis, patient anxiety and funding cost of repeat biopsies (2). Studies suggest rapid on-site evaluation (ROSE) by an experienced cytologist can reduce rates of non-diagnostic samples (1, 3-5).

A retrospective study was undertaken analysing all thyroid FNABs performed in the 12 months prior to and 12 months following implementation of ROSE by an experienced cytologist. Inpatients and outpatients over the age of 18 were included in the study. Thyroid FNABs were performed by radiology trainees and staff specialists with experience ranging from 6 months to greater than 10 years. All inexperienced staff were trained in basic biopsy technique using a phantom. Following two passes with a 25-gauge needle, samples were immediately prepared and...

A total of 144 thyroid nodules were biopsied in the 2-year period. 74 nodules were included in the pre-ROSE control group and 69 included in the ROSE group. The Bethesda scores of all biopsied nodules were recorded. Thyroid Imaging Reporting & Data System (TI-RADS) score, age, sex and number of passes for each biopsied nodule were also recorded. No significant difference was found in the pre-biopsy characteristics of the pre-ROSE and ROSE groups. The rates of non-diagnostic (Bethesda 1) samples dropped from 26.7% in the...

This study demonstrated ROSE reduced the non-diagnostic thyroid FNAB samples from 26.7% to 17.4% within our institution, however this modest reduction in non-diagnostic samples did not reach statistical significance (Table 2). On the other hand, ROSE increased the number of FNAB passes which was shown to reach statistical significance (Table 2). This reduction in non-diagnostic samples may be attributed to the increased number of passes yielding more tissue at the suggestion of the attending cytologist however future larger, prospective studies are warranted to further assess...

Witt BL, Schmidt RL. Rapid Onsite Evaluation Improves the Adequacy of Fine-Needle Aspiration for Thyroid Lesions: A Systematic Review and Meta-Analysis. Thyroid. 2013;23(4):428-35. Saieg MA, Barbosa B, Nishi J, Ferrari A, Costa F. The impact of repeat FNA in non-diagnostic and indeterminate thyroid nodules: A 5-year single-centre experience. Cytopathology. 2018;29(2):196-200. Pastorello RG, Destefani C, Pinto PH, Credidio CH, Reis RX, Rodrigues TdA, et al. The impact of rapid on-site evaluation on thyroid fine-needle aspiration biopsy: A 2-year cancer center institutional experience. Cancer Cytopathology. 2018;126(10):846-52. Medina...