Insufficient Experience in Thyroid Fine-Needle Aspiration Leads to Misdiagnosis of Thyroid Cancer.
10.3803/EnM.2014.29.3.293
- Author:
Jung Il SON
1
;
Sang Youl RHEE
;
Jeong Taek WOO
;
Won Seo PARK
;
Jong Kyu BYUN
;
Yu Jin KIM
;
Ja Min BYUN
;
Sang Ouk CHIN
;
Suk CHON
;
Seungjoon OH
;
Sung Woon KIM
;
Young Seol KIM
Author Information
1. Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea. jtwoomd@khmc.or.kr
- Publication Type:Original Article
- Keywords:
Thyroid neoplasms;
Biopsy, fine-needle;
Diagnosis;
Diagnostic errors
- MeSH:
Biopsy, Fine-Needle*;
Diagnosis;
Diagnostic Errors*;
Humans;
Sensitivity and Specificity;
Thyroid Gland*;
Thyroid Neoplasms*
- From:Endocrinology and Metabolism
2014;29(3):293-299
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Fine-needle aspiration (FNA) of the thyroid is a widely accepted confirmatory test for thyroid cancer with high sensitivity and specificity. FNA is a simple procedure that is learned by many clinicians to enable accurate diagnosis of thyroid cancer. However, it is assumed that because the FNA test is a relatively simple procedure, its cytologic results are reliable regardless of the operator's experience. The aim of this study was to evaluate the differences in the diagnostic indices of FNA between operators with different levels of experience. METHODS: A total of 694 thyroid FNA specimens from 469 patients were reviewed, and were separated based on the experience of the clinicians who performed the procedure. One hundred and ninety were categorized in the experienced group, and 504 in the inexperienced group. All FNA results were then compared with histological data from surgically resected specimens, and the sample adequacy and diagnostic accuracy of the groups were compared. RESULTS: The age, gender, and nodule size and characteristics were similar in both groups. The sample adequacy rate was not significantly different between the experienced and nonexperienced groups (96.3% vs. 95.4%, P=0.682). However, the non-experienced group had a higher false-negative rate than the experienced group (6.4% vs. 17.2%, P=0.038), and the sensitivity of the FNA test also tended to be lower in the nonexperienced group (95.6% vs. 88.9%, P=0.065). CONCLUSION: These results suggest that FNA operators who have less experience may miss cases of thyroid cancer by performing the procedure incorrectly. As such, the experience of the FNA operator should be considered when diagnosing thyroid cancer. When clinicians are being trained in FNA, more effort should be made to increase the accuracy of the procedure; therefore, enhanced teaching programs and/or a more detailed feedback system are recommended.
