Endocrinol Metab.  2014 Sep;29(3):293-299. 10.3803/EnM.2014.29.3.293.

Insufficient Experience in Thyroid Fine-Needle Aspiration Leads to Misdiagnosis of Thyroid Cancer

• Son JI
• Rhee SY
• Woo JT
• Park WS
• Byun JK
• Kim YJ
• Byun JM
• Chin SO
• Chon S
• Oh S
• Kim SW
• Kim YS

• KMID: 2169465
• DOI: http://doi.org/10.3803/EnM.2014.29.3.293

Abstract

BACKGROUND
Fine-needle aspiration (FNA) of the thyroid is a widely accepted confirmatory test for thyroid cancer with high sensitivity and specificity. FNA is a simple procedure that is learned by many clinicians to enable accurate diagnosis of thyroid cancer. However, it is assumed that because the FNA test is a relatively simple procedure, its cytologic results are reliable regardless of the operator's experience. The aim of this study was to evaluate the differences in the diagnostic indices of FNA between operators with different levels of experience.
METHODS
A total of 694 thyroid FNA specimens from 469 patients were reviewed, and were separated based on the experience of the clinicians who performed the procedure. One hundred and ninety were categorized in the experienced group, and 504 in the inexperienced group. All FNA results were then compared with histological data from surgically resected specimens, and the sample adequacy and diagnostic accuracy of the groups were compared.
RESULTS
The age, gender, and nodule size and characteristics were similar in both groups. The sample adequacy rate was not significantly different between the experienced and nonexperienced groups (96.3% vs. 95.4%, P=0.682). However, the non-experienced group had a higher false-negative rate than the experienced group (6.4% vs. 17.2%, P=0.038), and the sensitivity of the FNA test also tended to be lower in the nonexperienced group (95.6% vs. 88.9%, P=0.065).
CONCLUSION
These results suggest that FNA operators who have less experience may miss cases of thyroid cancer by performing the procedure incorrectly. As such, the experience of the FNA operator should be considered when diagnosing thyroid cancer. When clinicians are being trained in FNA, more effort should be made to increase the accuracy of the procedure; therefore, enhanced teaching programs and/or a more detailed feedback system are recommended.

Keyword

Thyroid neoplasms; Biopsy, fine-needle; Diagnosis; Diagnostic errors

MeSH Terms

Biopsy, Fine-Needle*
Diagnosis
Diagnostic Errors*
Humans
Sensitivity and Specificity
Thyroid Gland*
Thyroid Neoplasms*

Figure

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  Fig. 1 Examples of difficult nodules (arrows). (A) Deep, small nodule, (B) nodule in the uppermost part of the right thyroid lobe, (C) dense, calcified nodule.

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  Fig. 2 An example of a potentially erroneous needle localization. (A) A bright echo (arrow) is visible in the ill-defined hypoechoic nodule of the right thyroid lobe. (B) However, the needle tip was localized in the deep portion of the lobe (arrow). The bright echo seen in (A) is in fact the needle shaft.

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