Endocrine Abstracts

Introduction: Thyroid fine needle aspiration (FNA) is routinely performed in thyroid nodular disease. It provides precious information about nodules’ cellular constitution and can help therapeutic management, notably through the use of Bethesda classification. Unfortunately, this test encounters a significant number of non-diagnostic (class I) results, which leads to uncertainty in providing the most appropriate support and potentially increasing patients’ anxiety. In our study, we were interested in appreciating the improvement of sample quality by checking the cellular content during FNA with the help of a microscope and using rapid on-site evaluation (ROSE) directly in the consultation room.

Design and methods: We conducted a retrospective study on 297 (69 males, 228 females; mean ages 54 and 55 respectively) fine needle aspirations, made between 2017 and 2024. Ultrasound appearance according to EU-TIRADS classification were respectively 131 EU-TIRADS 3 (44%), 68 EU-TIRADS 4 (23%), and 98 EU-TIRADS-5 (33%). In group A (ROSE, 67 patients), FNA was performed by the same operator (Operator A), spreading out a drop of the sample over a microscope slide. Samples were coloured using Diff-Quick method, and cellularity was evaluated under a microscope. If the cellularity was insufficient, another aspiration was made. Group B (230 patients) comprises cases of FNA performed without microscopic quality-control by operator A and others.

Results: 9 samples were classified as non-diagnostic in group A (13%) against 118 in group B (51%), P <0,0001. Looking at the samples taken by operator A (n = 146), ROSE procedure was performed in 67 cases whereas standard FNA procedure was used in 79 cases. 9 needle aspirations were classified as nondiagnostic in the first subgroup (13%) against 31 (39%) in the second one. P <0,0001. The proportion of different EU-TIRADS nodules in groups A and B was not significantly different.

Conclusion: Our study suggests the use of microscope and ROSE during FNA might improve the yield of fine needle aspiration by reducing the number of non-diagnostic samples. This method would help reduce the overall number of repeated biopsy sessions and allow the practician to offer a more refined exploration of thyroid nodular disease.

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Keywords: Fine needle aspiration, rapid on-site evaluation, Bethesda classification