The benefits of on-site cytology with ultrasoundguided fine needle aspiration in a one-stop neck lump clinic

2010 ◽  
Vol 92 (8) ◽  
pp. 660-664 ◽  
Author(s):  
A Ganguly ◽  
TE Giles ◽  
PA Smith ◽  
FE White ◽  
PP Nixon
Keyword(s):  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Fine Needle ◽  
One Stop ◽  
Neck Lump

scholarly journals Fine needle aspiration adequacy in a one-stop neck lump clinic: 2nd cycle improvement

2020 ◽  
Author(s):  
George McNally ◽  
Usama Fawzy Kamel ◽  
Sucha Hampal
Keyword(s):  
Head And Neck ◽  
Fine Needle Aspiration ◽  
Diagnostic Delay ◽  
Needle Aspiration ◽  
Specimen Preparation ◽  
Fine Needle ◽  
One Stop ◽  
Neck Lump ◽  
Cancer Guidelines ◽  
The One

The one-stop neck lump clinic at Warrington Hospital was established in 2011 in line with NICE head and neck cancer guidelines.1 They recommend that fine needle aspiration (FNA) is performed under ultrasound guidance in the presence of an onsite cytopathologist. This enables an immediate assessment of adequacy and repeat sampling as required on the same day to prevent diagnostic delay.2 The Royal College of Radiologists recommend a minimum adequacy rate of 70% for thyroid lesions. In 2014, a systematic review of 78 papers found an average FNA adequacy rate for all head and neck lesions of 90.7%.3 Methods: This re-audit aimed to evaluate whether local recommendations for improving the performance of ultrasound. Data collected retrospectively between August 2017 and January 2018 were compared to the first cycle audit (December 2015 May 2016). The adequacy of initial FNA samples were recorded and whether repeat aspirations were required. Samples were considered inadequate if the cytology report stated insufficient material for adequate diagnosis.4 The reasons for diagnostically inconclusive reports were documented. Results: FNA cytology reports for 62 patients (53% female) in the second cycle were compared to 56 patients (64% female) in the first cycle. All pathologies were included, except for patients with suspected lymphoma.The adequacy rate for initial FNA reports increased from 76% to 89%. The specific adequacy rates for thyroids, salivary glands and lymph nodes improved by 18%, 18% and 4% respectively Conclusion: Discussion with the local pathology and radiology departments after the initial audit generated recommendations to improve adequacy rates. The introduction of CytoRich fluid for thyroid specimen preparation significantly increased adequacy. Narrower bore needles reduce the risk of haemorrhagic samples and were used for repeat FNA sampling to successfully decrease inadequate reports.

scholarly journals The benefits of on-site cytology with ultrasound-guided fine needle aspiration in a one-stop neck lump clinic

2010 ◽  
Vol 92 (8) ◽  
pp. 660-664 ◽  
Author(s):  
A Ganguly ◽  
TE Giles ◽  
PA Smith ◽  
FE White ◽  
PP Nixon
Keyword(s):  
Fine Needle Aspiration ◽  
Ultrasound Guidance ◽  
Clinical Excellence ◽  
Needle Aspiration ◽  
University Hospital ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
One Stop ◽  
Neck Lump ◽  
Set Up

INTRODUCTION In the National Institute for Health and Clinical Excellence (NICE) guidance on cancer services published in 2004, it was recommended that specialist clinics should be set up for the assessment of patients with neck lumps, structured in a similar way to one-stop breast lump clinics with a cytopathologist present and preferably ultrasound guidance. The aim of this study was to audit the performance of ultrasound-guided fine needle aspiration (FNA) with on-site cytology in a one-stop neck lump clinic at The Royal Liverpool University Hospital. PATIENTS AND METHODS Data were collected between November 2008 and May 2009 (7 months). Details of the adequacy rate for the FNA were recorded and whether multiple passes were required. The likely adequacy rate if ultrasound guidance was not available was also calculated. RESULTS A total of 274 patients were included in the audit. Of these, 227 (83%) patients required a single pass for adequate diagnostic material. Of the remaining, 45 (16%) required two passes and 2 (1%) required three passes. The overall sample inadequacy rate was 11 of 274 (4%). From these results, it could be predicted that, if immediate cytological evaluation was unavailable, the inadequacy rate would have been 41 of 274 (15%). CONCLUSIONS This audit has illustrated the benefits of a one-stop clinic with on-site cytology in providing a rapid diagnostic head and neck cancer service.

Comparison of cytopathological and histological results in 1,053 fine-needle aspiration cytology of breast lesions performed in a one-stop clinic

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 635-635
Author(s):  
I. Borget ◽  
C. Caramella ◽  
C. Balleyguier ◽  
V. Suciu ◽  
C. Uzan ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
False Negative ◽  
Needle Aspiration ◽  
Breast Lesions ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
One Stop ◽  
Needle Aspiration Cytology ◽  
Histological Results ◽  
Radiologic Features

635 Background: Fine-needle aspiration cytology (FNAC) has been used extensively in the diagnosis of breast lesions, but false-negative rates are a matter of concern. However, immediate onsite evaluation of breast lesions, combining FNAC results with clinical and radiological data allows to improve its diagnostic accuracy. The objective of this study was to evaluate the concordance between cytopathological and histological results in a large series of FNAC performed during the first 3-yr period of the dedicated one-stop clinic set up in our institution since 2004. Methods: We reviewed data of all patients (pts) seen in the one stop clinic between May 2004 and March 2007 who had a lesion diagnosed by FNAC and verified by histology. For benign lesions, histological verification of the lesion was mandatory each time there was no perfect concordance between clinico-radiologic features and FNAC results (such as benign FNAC but BI-RAD 5). Pts characteristics, radiological findings, cytopathological and histological (by per-cutaneous biopsy or surgery) results were extracted from the hospital computerized prospectively registered medical records. Results: A total of 1053 nodular breast lesions (mean size: 24±23 mm, BI-RAD ACR 1/2/3/4/5: 2/10/68/283/684) in 1015 pts (mean age: 59±13 years) were studied. FNAC was US-guided in 521 lesions (49.4%). FNAC classified lesions as malignant in 741 (70.4%), benign in 127 (12.0%), suspicious in 143 (13.6%), and unsatisfactory in 42 (4.0%) cases. Among definitive benign or malignant diagnosis, FNAC and histological results showed concordance in 840/868 (96.7%) cases (738 malignant and 102 benign cases). The numbers of false-negative and false-positive lesions were respectively 25/127 (19%) and 3/741 (0.4%). Among the 143 suspicious and 42 unsatisfactory specimens, 114 and 20 were malignant, respectively. Conclusions: FNAC performed in a one-stop clinic allows obtaining an immediate on-site diagnosis of breast cancer with a good concordance with histological results and low rate of unsatisfactory specimens. However, affirming benign lesion requires a multi-disciplinary team: whenever clinico-radiologic features and FNAC results are non concordant, histologic assessment is mandatory. No significant financial relationships to disclose.

How good are we at fine needle aspiration cytology?

2010 ◽  
Vol 124 (7) ◽  
pp. 765-766 ◽  
Author(s):  
S Carr ◽  
V Visvanathan ◽  
T Hossain ◽  
S Uppal ◽  
P Chengot ◽  
...  
Keyword(s):  
Lymph Node ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Ultrasound Guidance ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Study Results ◽  
Neck Lump ◽  
Needle Aspiration Cytology

AbstractObjectives:To determine the accuracy of fine needle aspiration cytology conducted within a standard ENT out-patients service (rather than a one-stop neck lump clinic), and also to assess the value of ultrasound guidance during fine needle aspiration cytology.Design:Retrospective study of all patients undergoing fine needle aspiration cytology of a neck lump, from 2005 to 2008 in Leeds teaching hospitals.Main outcome measures:Accuracy of fine needle aspiration cytology, compared with the corresponding histology report of the original surgical specimen, and non-diagnostic fine needle aspiration cytology rates with and without ultrasound.Results:Fine needle aspiration cytology yielded the following respective sensitivity, specificity and accuracy rates: 85, 91 and 87 per cent for lymph nodes; 80, 93 and 89 for salivary glands; and 52, 80 and 69 for thyroid. The proportion of non-diagnostic procedures was 28 per cent, both with and without ultrasound guidance.Conclusion:Cytologist-led fine needle aspiration cytology would have reduced the time to diagnosis and the number of clinic visits per patient. Fine needle aspiration cytology was accurate for predicting malignancy in salivary gland and lymph node lesions, and for diagnosing lymph node pathology. Study results did not support the use of ultrasound guidance during fine needle aspiration cytology.

Neck lump clinics: is on-site assessment of fine needle aspirate diagnostic adequacy cost-effective?

2013 ◽  
Vol 127 (11) ◽  
pp. 1122-1126 ◽  
Author(s):  
C Burgess ◽  
L Dias ◽  
E Maughan ◽  
R Moorthy
Keyword(s):  
Fine Needle Aspiration ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Needle Aspiration ◽  
Benefit Analysis ◽  
Ultrasound Guided ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Neck Lump ◽  
Needle Aspiration Cytology

AbstractObjectives:To establish the diagnostic adequacy of ultrasound-guided fine needle aspiration cytology samples at the East Berkshire neck lump clinic, and to perform a cost-benefit analysis related to the hypothetical addition of an on-site cytology technician (required to review fine needle aspiration specimen adequacy).Method:The adequacy of all ultrasound-guided fine needle aspiration procedures was reviewed from 1 January to 30 June 2011. These results were used in the cost-benefit analysis related to on-site cytology assessment.Results:Of the 307 ultrasound-guided fine needle aspiration cytology procedures performed over 6 months, 67 (22 per cent) were reported to be non-diagnostic. Operator experience was found to correlate significantly with diagnostic adequacy (p < 0.001). Only 5 per cent of all fine needle aspirations were initially non-diagnostic but diagnostic on repeat sampling. This suggests that the financial and time costs of on-site fine needle aspirate adequacy assessment would outweigh any benefit.Conclusion:In this series, the experience of individuals performing fine needle aspirations was the most important factor related to adequacy.

scholarly journals On-site cytotechnician evaluation of the adequacy of fine needle aspiration in a neck lump clinic

2013 ◽  
Vol 95 (8) ◽  
pp. 595-598 ◽  
Author(s):  
VM Reddy ◽  
WO Bennett ◽  
E Bassett ◽  
DJ Cunliffe ◽  
LC Fryer ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Absolute Risk ◽  
Test Group ◽  
Absolute Risk Reduction ◽  
Needle Aspiration ◽  
Control Group ◽  
Number Needed To Treat ◽  
Fine Needle ◽  
Neck Lump ◽  
The Impact

Introduction The gold standard for assessing neck lumps is a one-stop clinic with an on-site cytopathologist who can provide an immediate fine needle aspiration (FNA) report. However, this has considerable resource implications and is not available in all units. In our department, surgeons perform FNAs guided by palpation. The FNA is evaluated for specimen adequacy by an on-site cytotechnician. This study evaluated the impact of the cytotechnician on the adequacy of neck lump FNA. Methods FNA performed between June 2010 and February 2012 was examined. The FNA performed at a neck lump clinic with an assessment of adequacy by an on-site cytotechnician were considered the test group. All other neck lump FNAs from other sources without an assessment of adequacy by an on-site cytotechnician were considered the control group. Results Of the FNAs, 134 met the inclusion criteria for this study. Of these, 87 FNAs (65%) were analysed for adequacy by the on-site cytotechnician and the remaining 47 (35%) were not. The results demonstrated an FNA inadequacy with and without on-site cytotechnician assessment of 29.9% and 40.4% respectively. This is equivalent to an absolute risk reduction of an inadequate FNA of 10.5%, which equates to a number needed to treat of 9.5, ie the cytotechnician needs to assess 9.5 (ie the cytotechnician […] specimen). Conclusions In neck lump clinics where on-site cytopathology is not available, an on-site cytotechnician is a compromise measure that does reduce the number of inadequate FNAs.

Sign in / Sign up

Export Citation Format

Share Document