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Improving our departmental reporting of thyroid cytology specimens against national guidelines: A two‐cycle retrospective audit
Author(s) -
Halliday Edwin,
Harrison Eleanor,
Sansom Hugh,
Ahsan Syed Farhan,
Harrison Katherine
Publication year - 2020
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/cyt.12834
Subject(s) - medicine , cytology , retrospective cohort study , histology , fine needle aspiration cytology , thyroid , audit , radiology , pathology , accounting , business
In the UK, guidelines from the Royal College of Pathologists (RCPath) facilitate consistent and reproducible reporting and classification of fine needle aspiration cytology (FNAC) thyroid specimens. The aim was to audit our department against RCPath guidelines to refine and improve our reporting process. Methods Two‐cycle retrospective observational audit of all patients undergoing thyroid FNAC over a 2‐year period (1 year for each cycle). Final histology was correlated. The positive predictive value (PPV) for malignant neoplastic lesions was calculated; for Thy1, Thy1c, Thy2 and Thy2c all cases without final histology were assumed to be benign, while for Thy3a, Thy3f, Thy4 and Thy5 samples the PPV calculation was based only on those cytology samples with corresponding histology. False positive and false negative cases were reviewed. Results In total, 288 cytology samples were included in the first cycle; 96 (33.3%) had corresponding histology. There were 287 samples included in the second cycle; 119 (41.5%) had follow‐up histology. The rate of non‐diagnostic samples (Thy1/1c) decreased from 39.6% to 30.0%. The PPV for malignant neoplastic lesions was Thy1/1c 2.6%, Thy2/2c 0.0%, Thy3a 40.0%, Thy3f 19.4%, Thy4 75.0%, Thy5 100.0% (first cycle); Thy1/1c 4.7%, Thy2/2c 0.7%, Thy3a 13.3%, Thy3f, 7.7%, Thy4, 50.0%, Thy5 100.0% (second cycle). Conclusions Our department was able to reduce the rate of non‐diagnostic FNAC samples and improve the diagnostic accuracy of FNAC. Auditing local outcomes helps refine and improve the reporting process. Review of false positive and false negative cases helps examine potential pitfalls of cytology.