Surgeon‐performed ultrasound‐guided FNAC with on‐site cytopathology improves adequacy and accuracy

Objective To demonstrate that surgeon‐performed fine‐needle aspiration cytology (FNAC) results in a high percent of satisfactory FNAC results; the number of passes to obtain a satisfactory cytological result with on‐site cytopathological interpretation is reduced with ultrasound guidance (comparing FNAC with and without surgeon‐performed ultrasound guidance); and immediate triage for indeterminate thyroid nodules can be performed in one setting for molecular testing, potentially improving selection for surgery. Study Design Retrospective cohort comparison. Methods A cytopathologist is present for on‐site staining adequacy evaluation and molecular testing triage for indeterminate cytology. Overall cytological adequacy and number of passes required to obtain cytological adequacy for 200 consecutive patients are compared with a historical series of 100 consecutive patients from the same surgeon and cytopathologists without ultrasound guidance. Results The percent of patients with an adequate FNAC with ultrasound guidance was 100%. The mean number of passes with and without ultrasound guidance was 1.7 and 4.0 ( P  < 0.001). Indeterminate FNACs (9%) were triaged to molecular alteration testing and gene expression classifier testing. Conclusions Surgeon‐performed ultrasound‐guided FNAC with an experienced cytopathologist present resulted in a cytologically adequate result in 100% of cases. Significantly fewer passes for a satisfactory result were achieved with ultrasound guidance. Indeterminate FNAC can be triaged for molecular testing in one patient visit, was required in only 9% of carefully selected patients, and improved patient selection for surgery. The percent of patients who went on to surgery was 24 of 200 (12%). The percent of patients who had malignancy was 18 of 24 (75%). Level of Evidence 4. Laryngoscope , 125:1633–1636, 2015