Diagnostic cytopathology · 2025
Fine Needle Aspiration of Thyroid Nodules: From Conventional Smears to Liquid-Based Cytology-The 8-Year Cleveland Clinic Abu Dhabi Experience.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Nahal Ayoub
Аннотация
BACKGROUND: The transition from conventional smear (CS) cytology to liquid-based cytology (LBC) in thyroid fine-needle aspiration (FNA) has been a subject of debate, with varying reports on diagnostic performance. This retrospective observational study evaluates this institution's 5-year experience with LBC in thyroid cytology from 2020 to 2024, comparing its advantages and results with past experience using CS combined with rapid on-site assessment (ROSE) from 2016 to 2018, and correlating cytological diagnoses with histopathological outcomes.
METHODS: We performed a retrospective analysis of all thyroid FNAs processed and reported at the cytopathology department of Cleveland Clinic Abu Dhabi-National Reference Laboratory (CCAD/NRL) using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). A total of 741 nodules were aspirated from January 2016 to May 2018 using primarily conventional smears with the routine practice of ROSE (pre-LBC), while 4993 nodules were aspirated via LBC (ThinPrep) between July 2020 and September 2024 without ROSE (post-LBC). Cases with subsequent surgical resection were reviewed and correlated with the pre-operative cytology diagnosis to assess diagnostic accuracy. Data analysis before and after transitioning to LBC was performed to compare diagnostic performance, Bethesda category distribution, and surgical outcomes.
RESULTS: LBC was associated with improved pre-analytical standardization, with nondiagnostic rates stabilizing at 10.8% compared with 4%-7% during the pre-LBC period when ROSE was routinely used. The atypia of undetermined significance (AUS; Bethesda III) rate significantly decreased from 16% pre-LBC to 7% post-LBC, with architectural atypia alone comprising 3% post-LBC. Histologic correlation was available for 199 pre-LBC and 258 post-LBC nodules. Pre-LBC cytology demonstrated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 80.8%, 95.1%, 93.3%, and 85.3%, respectively. Post-LBC metrics improved to 92.3% sensitivity and PPV, and 98.8% specificity and NPV. Among Bethesda II nodules, the false-negative rate decreased from 14.3% pre-LBC to 2.3% post-LBC. AUS nodules with nuclear atypia demonstrated a 92.3% malignancy rate post-LBC, compared to 40.4% in unstratified AUS cases pre-LBC. Oncocytic cell-rich indeterminate nodules were predominantly benign in both cohorts.
CONCLUSION: LBC is associated with several practical advantages over CS in thyroid cytology. In addition to streamlining and standardizing diagnostic workflows, it significantly helped to improve diagnostic accuracy. We observed a significant decrease in AUS rate, reducing interpretive uncertainty, and enhanced detection of malignancy with nuclear atypia. These findings validate Bethesda's recommendations for more granular classification of indeterminate cytology. The nondiagnostic rate increased slightly in the post-LBC period, a predictable effect of ROSE withdrawal. However, this modest rise was offset by the substantial gains in workflow efficiency and overall diagnostic accuracy achieved with LBC. This long-term experience reinforces LBC as a reliable and efficient method for thyroid FNA evaluation and better risk stratification.
METHODS: We performed a retrospective analysis of all thyroid FNAs processed and reported at the cytopathology department of Cleveland Clinic Abu Dhabi-National Reference Laboratory (CCAD/NRL) using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). A total of 741 nodules were aspirated from January 2016 to May 2018 using primarily conventional smears with the routine practice of ROSE (pre-LBC), while 4993 nodules were aspirated via LBC (ThinPrep) between July 2020 and September 2024 without ROSE (post-LBC). Cases with subsequent surgical resection were reviewed and correlated with the pre-operative cytology diagnosis to assess diagnostic accuracy. Data analysis before and after transitioning to LBC was performed to compare diagnostic performance, Bethesda category distribution, and surgical outcomes.
RESULTS: LBC was associated with improved pre-analytical standardization, with nondiagnostic rates stabilizing at 10.8% compared with 4%-7% during the pre-LBC period when ROSE was routinely used. The atypia of undetermined significance (AUS; Bethesda III) rate significantly decreased from 16% pre-LBC to 7% post-LBC, with architectural atypia alone comprising 3% post-LBC. Histologic correlation was available for 199 pre-LBC and 258 post-LBC nodules. Pre-LBC cytology demonstrated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 80.8%, 95.1%, 93.3%, and 85.3%, respectively. Post-LBC metrics improved to 92.3% sensitivity and PPV, and 98.8% specificity and NPV. Among Bethesda II nodules, the false-negative rate decreased from 14.3% pre-LBC to 2.3% post-LBC. AUS nodules with nuclear atypia demonstrated a 92.3% malignancy rate post-LBC, compared to 40.4% in unstratified AUS cases pre-LBC. Oncocytic cell-rich indeterminate nodules were predominantly benign in both cohorts.
CONCLUSION: LBC is associated with several practical advantages over CS in thyroid cytology. In addition to streamlining and standardizing diagnostic workflows, it significantly helped to improve diagnostic accuracy. We observed a significant decrease in AUS rate, reducing interpretive uncertainty, and enhanced detection of malignancy with nuclear atypia. These findings validate Bethesda's recommendations for more granular classification of indeterminate cytology. The nondiagnostic rate increased slightly in the post-LBC period, a predictable effect of ROSE withdrawal. However, this modest rise was offset by the substantial gains in workflow efficiency and overall diagnostic accuracy achieved with LBC. This long-term experience reinforces LBC as a reliable and efficient method for thyroid FNA evaluation and better risk stratification.