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Diagnostic value and cost‐effectiveness of on‐site evaluation of fine‐needle aspiration specimens: Review of 5,688 cases
Author(s) -
Nasuti Joseph F.,
Gupta Prabodh K.,
Baloch Zubair W.
Publication year - 2002
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.10065
Subject(s) - medicine , triage , fine needle aspiration , medical physics , cost effectiveness , quality assurance , radiology , biopsy , emergency medicine , pathology , risk analysis (engineering) , external quality assessment
Fine‐needle aspiration (FNA) has proven to be a safe, economical, accurate, and rapid diagnostic technique. A successful FNA requires a specimen with adequate cellularity, high‐quality preparation, an experienced aspirator, and cytopathologist. Up to 32% of FNAs in various organs (thyroid, breast, lung, etc.) may be nondiagnostic due to scant cellularity and poor preparation. On‐site immediate evaluation of FNA specimens can be beneficial in determination of adequacy: triage for ancillary studies and provide a preliminary diagnosis of the specimen, which often facilitates rapid clinical decisions. In this study, we compared the on‐site FNA interpretation with the final diagnosis and calculated its cost benefit. Reports of 5,688 on‐site FNA cases from the files of the University of Pennsylvania Medical Center over a 5‐yr period (1/1/96–12/31/00) were reviewed. Data of the immediate on‐site interpretation and the final diagnosis in each case were compared to determine the diagnostic accuracy, clinical utility, and cost‐effectiveness of on‐site FNA evaluation. At our institution the average cost per FNA based on laboratory technical and professional fees ($1,743) and the weighted average cost, based on utilization, of ancillary laboratory studies ($328) and guidance procedures ($1,025) is $3,096. An additional fee of $231 per case is charged for on‐site FNA evaluation by an attending cytopathologist. The average reported rate of nondiagnostic FNAs without on‐site evaluation is 20%. Our own nondiagnostic rate for FNAs with on‐site evaluation is 0.98%. If one assumes that patients will undergo a repeat FNA for each nondiagnostic specimen, the estimated additional cost in direct institutional charges is $2,022,626 over 5 yr or $404,525 per yr without on‐site evaluation. This potential cost savings would be realized by utilizing on‐site evaluation despite the additional fee due to a higher rate of specimen adequacy. Based on this study, on‐site cytopathologic evaluation of FNA specimens is accurate, cost‐effective, and has improved patient care at our institution. Diagn. Cytopathol. 2002;27:1–4. © 2002 Wiley‐Liss, Inc.