Learning curve of thyroid fine-needle aspiration biopsy

Abstract

Background: Fine-needle aspiration biopsy (FNAB) is the reference procedure for thyroid nodule evaluation. Its main limitation are inadequate samples, which should be less than 20%.

Objective: To analyze the learning curve of the procedure by comparing the results of a non-experienced endocrinologist (endocrinologist 2) to those of an experienced one (endocrinologist 1).

Material and methods: Sixty FNABs were analyzed from February to June 2016. Each endocrinologist made 2punctures of every nodule in a random order. This order and the professional making every puncture were unknown to the pathologist who examined the samples.

Results: Endocrinologist 1 had a higher percentage of diagnoses than endocrinologist 2 (82% vs. 72%, P=.015). In the first 20 FNABs, the difference between both physicians was remarkable and statistically significant (80% vs. 50%, P=.047). In the following 20 FNABs, the difference narrowed and was not statistically significant (90% vs. 65%, P=.058). In the final 20 FNABs, the difference was minimal and not statistically significant (75% vs. 70%, P=.723).

Conclusions: The learning curve of ultrasound-guided FNAB may be completed in a suitable environment by performing it at least 60 times. Although the guidelines recommend at least 3punctures per nodule, 2are enough to achieve an accurate percentage of diagnoses.

Keywords: Curva de aprendizaje; FNAB; Fine needle aspiration biopsy; Learning curve; PAAF; Punción aspiración con aguja fina; Thyroid; Tiroides.