Thyroid Biopsy 101: Endocrinologists are better at adequacy than radiologists.
5% of biopsies done by radiologists are inadequate and patients need rebiopsy.The first biopsy should have been done by an endocrinologist to save patients for a traumatic return for a second biopsy.
Endocrinology had a higher rate of cytologic adequacy than radiology.
- Radiology had a higher rate of molecular adequacy than endocrinology.
- One institution had all thyroid biopsies done by either endocrinologists or radiologists only.
- The study comprised 5,810 specimens from Endocrinology and 4,597 from Radiology.
- More Endocrinology specimens were satisfactory for cytology diagnosis than those from Radiology (94.7% vs. 90.0%, p<0.001)
- For molecular adequacy, fewer Endocrinology specimens were optimal than specimens from Radiology for both the 7-gene panel era (76.2% vs. 82.9%, p<0.001) and the ThyroSeq era (88.1% vs. 91.9%, p=0.049).
- Because adequacy in cytology is the key starting point when most never need molecular marker studies as they are benign or diagnostic or high risk for cancer.
- The 20 % Class III needing markers can still get as good as radiologists with their Thyro/Seq system. 88% to 91.9%
- Go with an endocrinologists to do your biopsy.
- Radiologists tend to use bigger needles and get blood which cause bloody distortion of the cells.
- They also tend to use thin prep which is less valuable than smears for fine tuning the diagnosis.
- Endocrinologists make smears rather than thin prep in most cases.
- The usual procedure is to jam one or two times and put the bloody fluid in a thin prep tube.
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