Cytotechnologists today: much more than "pap-ologists" with schools in need of our support

Cytotechnologist Performance for Screening Hürthle Cell Atypia in Indeterminate Thyroid Fine-Needle Aspirates

OBJECTIVES

We have previously shown that specimens diagnosed as containing Hürthle cells have a 12% chance of being malignant if they are classified as atypia of undetermined significance (AUS-HC). The identification of Hürthle cells by cytotechnologists (CTs) during screening can improve cytopathologist efficiency and may prevent diagnostic errors due to the oversights of focal findings. Here, we examine the performance of our institutional CTs when screening for Hürthle cell atypia in thyroid fine-needle aspiration (FNA) specimens.

STUDY DESIGN

Information on 8,814 thyroid cytopathology specimens was retrieved for a 10-year period. Specimens were screened by 1 of 11 CTs. A subsample of cases was categorized either as AUS-HC or suspicious for Hürthle cell neoplasm.

RESULTS

AUS-HC screening diagnoses were more likely to be downgraded to benign but less likely to be upgraded compared to AUS diagnoses with nuclear or microfollicular atypia. AUS-HC represents almost all papillary thyroid carcinoma (PTC) screening diagnoses downgraded to the AUS category, which suggests that even low levels of Hürthle cell atypia can result in PTC being included in the differential diagnosis.

CONCLUSION

Overall, there are few major discrepancies between CT and pathologist diagnoses for specimens containing Hürthle cell atypia.

Cytotechnologist performance for screening microfollicular atypia in indeterminate thyroid fine-needle aspirates

INTRODUCTION

We previously identified a high level of accuracy among our cytotechnologists (CTs) for identifying nuclear atypia in thyroid fine-needle aspiration (FNA) specimens. Herewith, we present our CT performance at screening for microfollicular atypia.

METHODS

8,814 thyroid FNA specimens were identified in our archives, all screened by 1 of 11 CTs and signed out by a cytopathologist. A subsample of cases was categorized either as atypia of uncertain significance (AUS) with microfollicular proliferation (AUS-F) or suspicious for a follicular neoplasm (SFN).

RESULTS

The agreement rate was low between CTs and cytopathologists for SFN and AUS-F. Only 55.8% of SFN screening diagnoses were upheld; 27.9% were downgraded to AUS, 10.4% were downgraded to benign, and 5% were upgraded. Of AUS-F screening diagnoses, 35.5% were upheld, 33.7% were downgraded to benign, and 20.2% were upgraded to SFN. Among all cases, two-step discrepancies were uncommon.

CONCLUSION

Most disagreements were one-category discrepancies between AUS-F and SFN. The evaluation of microfollicular atypia is challenging given that certain follicular lesions cannot be definitively diagnosed on cytology, a high level of subjectivity is involved in the interpretation of such lesions, and the presence of nuclear or Hurthle cell atypia may complicate the diagnosis.

Cytotechnologist performance for detecting nuclear atypia in indeterminate thyroid fine needle aspirates

INTRODUCTION

The thyroid gland is arguably the fastest growing anatomic site for fine needle aspiration (FNA). With the increase of thyroid cases, a reevaluation of cytotechnologist screening quality metrics in terms of thyroid FNA is called for. We present our institutional cytotechnologist performance at screening for nuclear atypia by applying established quality metrics.

MATERIALS AND METHODS

Information on 8,814 consecutive thyroid cytopathology cases over a 10-year period was retrieved from computerized records. A subsample of cases categorized either as atypia of uncertain significance with nuclear atypia or suspicious for malignancy with features suspicious for papillary thyroid carcinoma. The cytotechnologist and cytopathologist diagnoses were compared using step discrepancies and Δ-ratios.

RESULTS

Overall discrepancy between the cytotechnologist and cytopathologist diagnoses existed in <10% of all thyroid cases. One-category discrepancies were the most common (7.8%), while two-category discrepancies were rare (0.5%). The one-category discrepancy rate correlated with cytotechnologist experience. One-category under calls were twice as common as over calls (5.3 vs. 2.5%, p < 0.0001).

CONCLUSIONS

We identified a high level of quality in the screening for nuclear atypia in thyroid FNA. The one-category discrepancy rate is suited to tracking individual cytotechnologist performance, identifies outliers and appears to correlate with cytotechnologist experience.

Cytology workforce study: a report of current practices and trends in New York State

A survey was conducted among 130 New York State (NYS) registered cytology laboratories to better understand current and future changes in the practice of cytology, changes in the cytotechnologist (CT) scope of practice, and the future need for CTs. A 51.5% (67/130) response rate was obtained. Trends for gynecologic case volume varied across facility types. Nongynecologic volume is growing primarily in hospitals and large medical center laboratories and private laboratories; the fine-needle aspiration volume is growing in hospital and large medical center laboratories. One third of responding laboratories anticipate a continued demand for CTs within the next 3 years owing to impending retirements. Few laboratories also report the gradual adoption of molecular testing with CTs directly involved. Because 60% (3/5) of NYS CT training programs have closed since 2008, the 2 remaining programs are a valuable key staffing resource for CTs. Continued viability of these programs is essential to provide the necessary training and staffing of NYS laboratories for cytopathology practice.