Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul-Sep;18(3):343-349.
doi: 10.4183/aeb.2022.343.

THE LEARNING CURVE AND PERFORMANCE OF A NEWLY ESTABLISHED THYROID FINE-NEEDLE ASPIRATION CENTER

L G Deacu  1 , D A Niculescu  1   2 , D Terzea  3 , C Cristea  3 , D Ioachim  3 , C Poiana  1   2
Affiliations

THE LEARNING CURVE AND PERFORMANCE OF A NEWLY ESTABLISHED THYROID FINE-NEEDLE ASPIRATION CENTER

L G Deacu et al. Acta Endocrinol (Buchar). 2022 Jul-Sep.

Abstract

Context: Thyroid fine-needle aspiration (FNA) cytology is the best tool for preoperative diagnosis of thyroid carcinoma; however, its learning curve is poorly described. Our aim was to assess the learning curve of a new thyroid FNA center involving unexperienced operator and pathologist.

Methods: We retrieved from our tertiary endocrinology center database all thyroid FNA procedures done by a single operator (endocrinologist with no experience in FNA) between 2018 and 2021. Cytology was assessed by two pathologists with limited or no experience in thyroid cytology. We also got the corresponding sex, age, nodule diameter, EU-TIRADS score, Bethesda category and final pathology report.

Results: There were 1872 FNA in 1618 patients. Proportion of Bethesda 1 nodules decreased significantly (p for trend=0.003) from 17% in the first 100 FNA procedures to 4% in the 401-500 group of procedures, and remained constant between 9% and 4% (p for trend=NS) for the rest of the study. Proportion of Bethesda 2 rose steady from 26% in the first 100 nodules to 80.1% in the last 241 nodules (p for trend<0.001). Indeterminate lesions (Bethesda 3 and 4) decreased significantly (p for trend=0.001) from 16% and 35% in the first 100 nodules to 2.5% and 5.8% in the last 241 lesions. Proportions of Bethesda 5+6 categories varied non-significantly over time. There were no time trends in the malignancy rate of surgically removed nodules.

Conclusions: At least 300 procedures are needed to reach the standard performance. A steadily state for the whole center is obtained after about 500 procedures.

Keywords: Bethesda category; learning curve; thyroid fine needle aspiration.

PubMed Disclaimer

Conflict of interest statement

All authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Figure 1
Figure 1
Percent with Bethesda category (1 – white bars; 2 – rightwards hatched bars; 3/4 – leftwards hatched bars; 5/6 – horizontally hatched bars) based on consecutive number of FNAs for cytopathologist 1 (P1 – white columns) and cytopathologist 2 (P2 – grey columns). Bethesda category is also marked in the first column.
Figure 2
Figure 2
Percent with Bethesda category (1 – white bars; 2 – rightwards hatched bars; 3 – cross hatched bars; 4 – leftwards hatched bars; 5/6 – horizontally hatched bars) based on consecutive number of FNAs for pathologist 1 in EU-TIRADS 3 (a), EU-TIRADS 4 (b) and EU-TIRADS 5 (c) nodules.
Figure 3
Figure 3
Rate of malignancy based on consecutive number of surgeries in Bethesda 2 (dotted line with squares), Bethesda 3/4 (dashed lined with triangles) and Bethesda 5/6 (solid line with circles) nodules. *, 1 out of the 2 nodules were non-invasive follicular neoplasm with papillary-like nuclear features (NIFTP). #, 2 out of the 3 nodules were NIFTP.
See this image and copyright information in PMC

References

    1. Pinchera A. Thyroid incidentalomas. Horm Res. 2007;68(5):199–201. - PubMed
    1. Wilhelm S. Evaluation of thyroid incidentaloma. Surg Clin North Am. 2014;94:485–497. - PubMed
    1. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, Paschke R, Valcavi R, Vitti P, Balafouta ST, Baloch Z, Crescenzi A, Dralle H, Frasoldati A, Gärtner R, Guglielmi R, Mechanick JI, Reiners C, Szabolcs I, Zeiger MA, Zini M. American association of Clinical Endocrinologists, American college of endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules-2016 update. Endocr Pract. 2016;22(5):622–639. - PubMed
    1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1–133. - PMC - PubMed
    1. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol. 2009;132:658–665. - PubMed

LinkOut - more resources