Rationale and Objectives
The aim of this study was to determine whether the diagnostic yield of thyroid fine-needle aspirations (FNAs) changes over the course of residency training.
Materials and Methods
We identified 5418 ultrasound-guided thyroid nodule FNAs performed in our radiology department from 2004 through 2012. For each FNA, we recorded if the FNA was performed by a resident and if so the name of the resident and supervising attending radiologist. For each resident, we determined the level of training based on their graduation year from our residency program and the date of the FNA as well as prior surgical training and if they completed subsequent interventional radiology fellowship. Pathology reports were reviewed, and FNAs were classified as diagnostic or nondiagnostic (ND). Generalized mixed models were used to assess ND rate with postgraduate years, including residents with and without prior surgical training or if they subsequently completed an interventional radiology fellowship.
Results
Of the 5418 thyroid FNAs, 3164 (58.4%) were performed by a radiology resident under the direct supervision of an attending physician. There was a significant decrease in ND rate as postgraduate years increased ( P < .05). A significant decrease in ND rate was found as postgraduate years increased for residents without prior surgical training ( P = .0007) or subsequent training in interventional radiology ( P = .0014); however, no significant decrease was found for residents with surgical training ( P = .37) or completing an interventional radiology fellowship ( P = .08). In addition, no significant difference was found for ND rate between postgraduate year 4 (PGY4) and PGY5 ( P > .05).
Conclusions
ND thyroid FNA rates progressively decrease with training level, suggesting that early and continued participation in procedures throughout residency improves outcomes. This is particularly true for residents without prior surgical training or subsequent interventional radiology fellowship.
Thyroid nodules are common and typically benign. Current clinical guidelines recommend fine-needle aspiration (FNA) of nodules > 1–1.5 cm, and of smaller nodules with concerning sonographic features . The reported diagnostic yield of thyroid FNA varies from 80% to 99%, with an average of 85% . Although it is well documented that diagnostic rates can be improved by routine onsite cytopathology evaluation for adequacy, it is expensive and inefficient, particularly at high volume centers . The effect of biopsy technique on nondiagnostic (ND) rates has also been studied. For example, two studies have demonstrated equal efficacy of aspiration versus suction-assisted FNA techniques . Visualization of the needle within the nodule along its long axis has been shown to improve diagnostic rates for deep nodules when compared with visualization along the needle’s short axis . Needle size seems to be relatively unimportant as studies comparing needles from 21 to 27 ga have not shown a diagnostic advantage of the larger bore needles .
One small study showed no difference in ND rates between an experienced attending radiologist and a new attending radiologist . Another study examining attending pathologists’ interpretations of thyroid FNA based on number of years of experience found that less experienced pathologists were more likely to interpret samples as ND or atypical, whereas more experienced pathologists were more likely to interpret samples as benign . To our knowledge, the effect of resident training level on ND thyroid FNA rates is unknown. The aim of this study was to determine whether the diagnostic yield of thyroid FNA changes over the course of residency training.
Materials and methods
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Results
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Table 1
ND FNA Rates by Level of Training, Comparing Residents with and without Prior Surgical Training, and Whether They Completed a Subsequent Interventional Radiology Fellowship
Level of Training ND Rate (%) Surgery (95% CI) No Surgery (95% CI) Interventional Radiology (95% CI) No Interventional Radiology (95% CI) PGY2 14.7 (10.5–20.2) 18.2 (15.6–21.3) 14.6 (11.1–19.0) 18.8 (16.0–22.0) PGY3 15.3 (10.3–22.0) 16.8 (14.4–19.6) 17.9 (13.2–23.9) 16.3 (13.8–19.2) PGY4 9.9 (5.2–18.1) 12.7 (10.2–15.6) 14.4 (9.4–21.3) 11.9 (9.5–14.8) PGY5 13.3 (9.0–19.1) 11.7 (9.1–14.8) 9.5 (6.0–14.7) 12.5 (9.8–15.8)
CI, confidence interval; FNA, fine-needle aspiration; ND, nondiagnostic; PGY, postgraduate year.
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Discussion
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