Liquid-based cytology improves productivity in cervical cytology screening.

Objectives: The ThinPrep test was introduced into our institution on a phased basis over 3 years between January 2002 and December 2004. This study set out to assess its effect on productivity (as measured by output of cases per medical scientist per day) during the changeover period. Numbers of high and low-grade lesions and of unsatisfactory slides were also monitored. Methods: The percentage conversion from conventional preparation to liquid-based cytology (LBC) and output of cases per medical scientist per day were calculated from our database at 6-month intervals. The average backlog, average number of cases received per month and percentage of unsatisfactory and abnormal cases were calculated similarly. Results: Over the study period 92 084 cases were received. The percentage of cases using ThinPrep increased: from 9% in January 2002 to 73% in December 2004. During the study there was an increase in output from 17.0 to 22.3 cases per medical scientist per day, representing a 31% improvement at 73% conversion. Numbers of unsatisfactory cases decreased substantially and the numbers of low and high-grade diagnoses were relatively constant. Conclusions: The change to ThinPrep has improved productivity and decreased the number of unsatisfactory cases. There was no adverse effect on quality during the changeover.     

Comparative study: conventional cervical and ThinPrep Pap tests in a routine clinical setting.

The conventional Papanicolaou smear is associated with variable false positive and false negative rates, difficulties with interpretation and high unsatisfactory and suboptimal rates. Newer fluid-based methods such as the ThinPrep 2000 system (Cytyc Corp., Boxborough, MA) are said to overcome these difficulties. The aim of this study was to compare the conventional smear with the ThinPrep method in a busy, routine cytology screening laboratory setting. One thousand split samples were evaluated. Using ThinPrep, the results showed an increased sensitivity and a dramatic improvement in specimen adequacy, with a combined 17.2% reduction in 'unsatisfactory' and 'suboptimal' reports. Screening time per slide was also reduced to 3-4 min. In conclusion, we report an increase in sensitivity, a reduction in screening time and a dramatic improvement in specimen adequacy with the ThinPrep method.     

Management of Sonographically Suspicious Thyroid Nodules 1 cm or Smaller and Candidacy for Active Surveillance: Experience of a Tertiary Center in China

ObjectiveOur objective was to investigate the management of patients with asymptomatic suspicious thyroid nodules ≤1 cm.MethodsWe retrospectively reviewed medical records of patients with sonographically suspicious thyroid nodules ≤1 cm and without distant metastases, suspicious lymph node metastasis (LNM), or extrathyroidal extension (ETE).ResultsOf the 386 enrolled patients, 174 (45.1%) had immediate surgery (IS), while 212 (54.9%) underwent active surveillance (AS). In the IS group, 166 (95.4%) patients were confirmed as having papillary thyroid microcarcinoma. LNM and ETE were observed in 24.7% and 2.4% cases, respectively. In the AS group, nodule size increased by ≥3 mm in 11 (5.2%) patients and 39 (18.4%) had a >50% increase in nodule volume after a median follow-up of 12 months. Nodules with smaller volume at diagnosis were more likely to increase in volume later. Newly suspicious LNM was detected in 23 (10.8%) patients. Delayed surgery (DS) was performed in 101 patients, with 27 showing disease progression. ETE and LNM were detected in 3% and 36%, respectively, of patients with papillary thyroid microcarcinoma. Compared with IS, tumors in the DS group more frequently showed lateral LNM and capsular invasion (P < .05). No patient had recurrence or died of thyroid cancer during postoperative follow-up (median 26 [4-60] months).ConclusionsIS or DS of patients with asymptomatic suspicious thyroid nodules ≤1 cm was relatively high in China. The inertia of low-risk nodules and the effectiveness of DS for those that progressed make AS a feasible strategy.     

Not All Bethesda 1 Thyroid Nodules Were Created Equal: Different B1 Subgroups

ObjectiveThe Bethesda System for Reporting Thyroid Cytopathology is a uniform method used worldwide to report thyroid fine-needle aspiration (FNA) outcomes. This study focuses on the Nondiagnostic/Unsatisfactory category, designated as Bethesda1 (B1). The documented risk of malignancy for B1 nodules can vary significantly, implying this category is not homogenous and might be composed of different subtypes. Our hypothesis was that B1 subgroups (blood only, insufficient thyrocytes, cyst content) will vary in their malignancy rate.MethodsThe study design was observational and retrospective. The study population included 154 patients in the Galilee Medical Center who underwent FNA examination of the thyroid gland from 2013-2018 and had a B1 result. We looked at the final diagnosis of malignant or benign for patients who underwent surgery and calculated the malignancy rate for each subgroup.ResultsMalignancy rates were higher in the Blood subgroup than in the other subgroups, and higher in the Thyrocytes subgroup than in the Cyst subgroup (P < .05). All malignancies were papillary thyroid carcinomas. There was no significant difference in the malignancy rate when we further divided the B1 samples into 2 groups based on the presence of epithelial cells. Many repeat FNA tests resulted in a different B1 subgroup.ConclusionThe different malignancy rates suggest that individual management approaches should be considered for each B1 subgroup.