A comparative audit of FNA Thyroid results with use of Spinal needle University Hospital Limerick T Kelly, C O’Rourke, T Scanlon, J O’Brien, P Kiely, J.E Fenton

Background Prior 2014 After 2014

Background Does the needle type really matter? Thinner needles (24-25G) Length of needle makes no difference Capillary action technique > aspiration Recent research states spinal needles > traditional needle

Background Spinal needles More expensive (€1-3 vs €0.05) Reduce inadequate cytological specimens due to use of stylet Comparison of inadequate specimen rates Blue needle = 18.7% Spinal w/o stylet = 13.8% Spinal w stylet = 3.1% Cappelli et al. Cost-effectiveness of fine-needle-aspiration cytology of thyroid nodules with intranodular vascular pattern using two different needle types. Endocr Pathol. 2005 Winter; 16(4):349-54

Introduction The aim of this study was to analyze FNAC results of thyroid nodules using 22G Spinal Needle Compare FNAC results with those using a traditional needle

Methods Comparative audit of all FNA thyroid samples January – June 2014 (6 months) 3 consultant radiologists All using spinal needle 22G Spinocan (stylet) Ultrasound scanner Philips iU22

Methods Examined Patient demographics Cytology Morphology Ultrasound report All results compared with previous years, using standard 23G blue needle.

Methods Technique Small variations between radiologists All use Local Anaesthetic 2-3 Needles used per nodule Capillary action used All use stylet

Results Total 91 patients Demographics Sex Age 100 nodules sampled Male – 14 (15%) Female – 77 (85%) Ratio 1:5 Age Range - 20 – 85 years Median – 55 years

Results

Results

Radiologist 1 Mean size of inadequate samples = 2.52cm Size (mean and range): thy1 2.68 cm (1-4.8cm) thy1c 2.18 cm (1-3.8cm) thy2 2.08 cm (1-3.9cm) thy2c 1.75 cm (1.5-2cm) thy3a 8.5 cm thy5 1.75 cm (1.4-2.1cm) Mean size of inadequate samples = 2.52cm thy1: 2cm, 1.6, 4.8, 1.2, 2.5, 1, 1.2, 4, 1.1, 4.8, 3.8, 4.2 mean 2.68; median between 2 and 2.5 thy2 colloid: 2.4cm, 1, 3.7, 1.8, 2, 2.2, 1, 2.1, 2.3, 1.5 thy2 hyperplastic: 1, 3.4, 3.9, 2.6, 2, 2, 1.5 thy2 cystic degeneration: 1.2 thy2 thyroiditis

Radiologist 2 Mean size of inadequate samples = 1.87cm Size (mean and range): thy1 1.8 cm (1.2-2.4cm) thy1c 1.98 cm (1.2-2.3cm) thy2 2.2 cm (0.8-4cm) thy2c 1.3 cm thy3f 1.6 cm thy4 1.8 cm thy5 2.66 cm (1.9-3.5cm) Mean size of inadequate samples = 1.87cm thy2: colloid 1.7cm, 2.8, 2.7, 1.3, 1.4, 1.4, 2.5, 2.8, 2.3, 1.8, thy2: hyperplastic 2.3cm, 2.3, 2.5, 1.5, 2.5, 1.7, 0.8, 2.5, 3.8, 1.2, 2.4, 4, 2.7, 2.1 (focal Hurtle cell change)

Radiologist 3 Mean size of inadequate sample = 3.4cm Size (mean and range): thy1c 3.4 cm thy2 2.1 cm (1.4-4cm) thy3a 2.25 cm (1.5-3cm) thy3f 3.5 cm thy4 3 cm thy2 colloid: 2, 1.6, 1.7, 1.5, 3 thy2 hyperplastic: 1.8, 2, 1.4, 2.7, 4, 1.5, 2.1

Radiologists 1-3

Results

Results Cost analysis (for 100 samples) Spinal needle: 100 × €1.50 × 3 = €450 Blue needle: 100 × €0.05 × 3 = €15 Consider repeat FNAC Current cohort: 87 × €1.50 × 3 = €391.50 (61 THY 2 + 26 THY 1) Total cost (per 100 samples) Spinal needle = €841.50 Blue needle = €28.05

Results Positive correlation with size of lesion and an inadequate cytology result Inadequate sample size = 2.5cm ≥ THY 2 = 1.4cm P < 0.05

Discussion Any benefit to use of spinal needle? Similar rate of inadequate samples with use of blue needle 26% vs 26% THY 1 Extra cost €1,600 extra cost per year to department

Discussion Larger nodules lead to more inadequate results Mean size THY 1 = 2.5cm Mean size ≥ THY 2 = 1.6cm Larger nodules = Greater blood supply

Limitations Single institution study Small number of patients Variability between Radiologists Large randomised prospective trial required

Conclusion Despite published literature there appears to be no added benefit to the use of spinal needles for FNAC of Thyroid lesions.

Thank you Questions?