Added value, decreased cost: the evolving role of the cytotechnologist for preliminary screening and triage of thyroid aspirates.

Immediate adequacy assessment for thyroid fine-needle aspirations (FNAs) is standard practice in many cytopathology laboratories. A pathologist is usually present for these time consuming assessments. The purpose of this 5 month study (January 2008-May 2008) was to show that cytotechnologists can accurately provide the majority of immediate adequacy assessments for thyroid FNAs, saving both time and money for pathologists, clinicians, and patients. The study consisted of 167 thyroid nodule FNAs performed in twice weekly thyroid FNA clinics. A comparison was made of the immediate assessments by five participating cytotechnologists and the preliminary and final diagnoses by three pathologists. The cytotechnologist prepared the slides, assessed the air-dried Hema-Diff™ stained slides for adequacy, and the pathologist viewed the slides remotely via real-time video streaming. Results were recorded in an Excel spreadsheet. There was a discordance rate of 1.2% when comparing the cytotechnologist's adequacy interpretation and the pathologist's preliminary diagnosis; both clinically insignificant. By cytotechnologist assessment, 79.0% of the cases were benign and 6.6% were nondiagnostic. 14.4% of the cases were assessed as cellular nodule or neoplastic lesion; all requiring pathologist's preliminary diagnosis. Utilizing a cytotechnologist to provide adequacy, instead of a pathologist, saved $464.10/case (2.38 passes/case) based on current gross technical and professional charges. On the basis of our findings, cytotechnologists can accurately provide immediate onsite adequacy assessments for thyroid nodule FNAs. Affording cytotechnologists the opportunity to preliminarily assess FNAs for adequacy also creates a new role in the laboratory. Furthermore, cost-savings are realized for patients and the health care system.
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