Rapid On-Site Evaluation With Telecytology Significantly Reduced Unsatisfactory Rates of Thyroid Fine-Needle Aspiration

A Case-Control Study

Diana M. Lin, MD; Jessica Tracht, MD; Frida Rosenblum, MD; Erik Kouba, MD; Deepti Bahl, MD; Anish Patel, MD; Isam-Eldin Eltoum, MD


Am J Clin Pathol. 2020;153(3):342-345. 

In This Article

Abstract and Introduction


Objectives: We evaluated telecytology rapid on-site evaluation (ROSE) for thyroid ultrasound-guided fine-needle aspiration. To the best of our knowledge, this study is the first case-control clinical trial of thyroid telecytology.

Methods: We introduced on-site ROSE in our institution's thyroid clinic for 6 months, followed by telecytology for 12 months. Our institution's ultrasound clinic, where ROSE is not provided, was used as a control group for each period.

Results: Both groups had similar initial unsatisfactory rates (thyroid clinic: 8.8%; ultrasound clinic: 8.0%) before the study began. The thyroid clinic's unsatisfactory rate was significantly reduced to 1.6% after on-site ROSE (P = .001) and to 3.8% after telecytology ROSE (P = .010), with no significant difference between on-site and telecytology ROSE periods (P > .05). The ultrasound clinic's unsatisfactory rate was unchanged for both periods. Concordance between telecytology ROSE and final adequacy was 97% (κ = 0.699).

Conclusions: Telecytology ROSE reduces unsatisfactory rates for ultrasound-guided fine-needle aspiration without compromising patient care.


Rapid on-site evaluation (ROSE) for thyroid ultrasound-guided fine-needle aspiration (UG-FNA) has been shown to significantly reduce the unsatisfactory/nondiagnostic (UN/ND) rate both in national studies[1] and at our own institution.[2] This reduction improves patient care by reducing repeated FNAs due to prior unsatisfactory specimens. Although most nodules are adequate on repeated FNA, extensive postprocedural infarction, fibrosis, and hemorrhage can hinder an adequate diagnosis in remaining cases. In addition, a small percentage of repeated FNA cases will be reported as "atypical" because of reactive follicular cells, endothelial cells, and fibroblasts.[3] These changes are most likely to occur when the FNA is repeated in less than 3 months.[3]

With improved imaging technology, thyroid ultrasound detects nodules in up to 68% of patients in the general population.[4] Providing on-site ROSE for these increasing thyroid FNAs is difficult for a limited number of pathologists who serve multiple clinic sites. To meet this demand, we recently instituted telecytology at our institution. To the best of our knowledge, this study is the first case-control clinical trial evaluating telecytology for thyroid UG-FNA.