Optimization Of The Techniques For Fine Needle Aspiration Of Thyroid Nodules

Thyroid nodules are the common clinical issue in the endocrine system disease.Epidemiological studies have shown that in areas with adequate iodine,palpable thyroid nodules prevalence is 5% in women and 1% in men respective.High-resolution ultrasound detected rate can be as high as 19-68%,and more common in women and the elderly.Epidemiological studies conducted before showed that the prevalence of thyroid nodules in 9533 adults over the age of 40 in Nanjing Gulou District Community was 46.6%.However,only 5% to 10% of thyroid nodules are malignant.With the improvement of ultrasound technology and update of thyroid aspiration techniques and the cytopathology diagnostic systems,many patients do not have to undergo surgery to obtain a definitive diagnosis of thyroid nodules.According to the latest American Thyroid Association(ATA)guidelines,ultrasound-guided thyroid fine-needle aspiration(FNA)is one of the essential steps in the diagnosis of thyroid nodules.However,the specific protocols of FNA vary widely among countries and regions,and there is no uniform standard.The satisfactory rate of thyroid FNA diagnosis is also uneven.From the choice of aspiration needle to the aspiration methods are still controversial.Our center implemented theinternationally standardized method of 25 G fine needle aspiration technology in 2014,combined with the use of non-suction aspiration method can significantly improve theconventional smears diagnostic rate,also the FNA skills had greatly improved and standardized.Our Center also introduced the SurePath technology,but the cell collection method is still in the initial stage,and the diagnostic rate between aspiration vs non-aspiration group remains unclear.We designed a prospective study to compare the impact of different methods of aspiration on cytopathological diagnostic rate using the SurePath method.All thyroid nodules were aspirated with internationally standardized method of 25 G fine needle aspiration technology.The first group was 4-needle per nodule,the first 2-needle was by SurePath method,andthe rest 2-needle was by conventional smears method,with or without aspiration during the operation.The second group of each nodule performing 2 needles using SurePath method,with or without aspiration during the operation.Total of 1683 thyroid nodules were selected in this study.These nodules underwent 4 different operations for FNA according to a pre-set sequence.A total of 879 nodules received the 4-needle method,of which 511 nodules were aspirated and the other 368 nodules were not aspirated.On the contrary,a total of 804 nodules received a 2-needle procedure,of which 424 nodules were aspirated and the other 380 nodules were not aspirated.We found that the use of internationally standardized method of 25 G fine needle aspiration technology,non-aspiration 2-needle smear diagnostic rate was stable,while the use of SurePath method could get a higher diagnostic rate with aspiration.Meanwhile the 2-needle or 4-needle method with aspiration using SurePath had higher accuracy rate vs non-aspiration group,and it is worth for further promotion in clinical work efficiency.Based on our previous result,we have verified that SurePath combined with traditional smear can improve the diagnostic accuracy rate,but no particularly advantageous was observed between these two group.After we improved the FNA technology,we performed a study to compare the influence of SurePath vs conventional smears method on cytopathological diagnosis.We enrolled a total of 965 thyroid nodules,each of which performed both methods of sampling.4-needle was sampled for each nodule,and SurePath was performed on the first 2 needle while conventional smears for the rest 2 needle.Our study suggests that FAN with SurePath has shown significant advantages over conventional smears,and may even replace conventional smear in our clinical work.The combination of the two above can improve the diagnostic rate,and make up for the shortcomings of the conventional smear method.It is worthy of further promotion and application of this optimization scheme.