J Pathol Transl Med.  2024 Sep;58(5):205-213. 10.4132/jptm.2024.06.24.

Educational exchange in thyroid core needle biopsy diagnosis: enhancing pathological interpretation through guideline integration and peer learning

• Harahap AS
• Jung CK

• KMID: 2559065
• DOI: http://doi.org/10.4132/jptm.2024.06.24

Abstract

Background
While fine needle aspiration cytology (FNAC) plays an essential role in the screening of thyroid nodules, core needle biopsy (CNB) acts as an alternative method to address FNAC limitations. However, diagnosing thyroid CNB samples can be challenging due to variations in background and levels of experience. Effective training is indispensable to mitigate this challenge. We aim to evaluate the impact of an educational program on improving the accuracy of CNB diagnostics.
Methods
The 2-week observational program included a host mentor pathologist with extensive experience and a visiting pathologist. The CNB classification by The Practice Guidelines Committee of the Korean Thyroid Association was used for the report. Two rounds of reviewing the case were carried out, and the level of agreement between the reviewers was analyzed.
Results
The first-round assessment showed a concordance between two pathologists for 247 thyroid CNB specimens by 84.2%, with a kappa coefficient of 0.74 (indicating substantial agreement). This finding was attributed to the discordance in the use of categories III and V. After peer learning, the two pathologists evaluated 30 new cases, which showed an overall improvement in the level of agreement. The percentage of agreement between pathologists on thyroid CNB diagnosis was 86.7%, as measured by kappa coefficient of 0.80.
Conclusions
This educational program, consisting of guided mentorship and peer learning, can substantially enhance the diagnostic accuracy of thyroid CNB. It is useful in promoting consistent diagnostic standards and contributes to the ongoing development of global pathology practices.

Keyword

Thyroid neoplasms; Large-core needle biopsy; Practice guideline; Education

Figure

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  Fig. 1. A case of discrepant diagnosis between two pathologists in a core needle biopsy specimen with papillary thyroid carcinoma. (A) The biopsy specimen presents a fibrotic lesion with few tumor cells. On high-power views (B, C), a few tumor cells with nuclear features of papillary carcinoma were observed. One pathologist interpreted this case as an indeterminate follicular lesion (category III), while the other pathologist diagnosed it as papillary carcinoma (category VI). (D) A matched tumor in a surgical specimen reveals paucicellular papillary carcinoma.

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  Fig. 2. A case of discrepant diagnosis between two pathologists in a core needle biopsy specimen with medullary thyroid carcinoma. (A) The biopsy specimen shows a tumor area with a mixed follicular and solid growth pattern, which has no fibrotic capsule and is detached from the surrounding normal thyroid tissue. (B) The tumor cells exhibit round to oval hyperchromatic nuclei and ill-defined amphophilic cytoplasm. One pathologist interpreted this case as an indeterminate follicular lesion (category III), while the other pathologist diagnosed it as medullary thyroid carcinoma (category VI). In the matched tumor in a surgical specimen (C, D), a well-defined medullary thyroid carcinoma is observed.

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  Fig. 3. A core needle biopsy specimen with non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) where two pathologists had discrepant diagnoses. (A) The biopsy specimen displays a follicular-patterned lesion that is separated from normal thyroid tissue by a thick fibrotic capsule. On the left side, the detached tumor tissue is visible. The histologic features of the tumor are not vastly different from normal tissue on a low-power view. (B) On a high-power view, subtle nuclear atypia is observed in tumor cells. One pathologist interpreted this case as an indeterminate follicular lesion (category III), while the other pathologist diagnosed it as follicular neoplasm with nuclear atypia (category IV). In the matched tumor in a surgical specimen (C, D), the tumor was diagnosed as NIFTP.

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  Fig. 4. Comparison of thyroid core needle biopsy diagnoses between two pathologists before and after peer learning in thyroid and parathyroid lesions. (A) In the first round (n = 237), the confusion matrix between pathologist 1 and pathologist 2 shows a concordance rate of 84.0% and a Cohen’s kappa coefficient of 0.73. (B) In the second round (n = 30), the confusion matrix between pathologist 1 and pathologist 2 demonstrates a concordance rate of 86.7% and a Cohen’s kappa coefficient of 0.80.

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Reference

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