Cost-effectiveness of fine-needle-aspiration cytology of thyroid nodules with intranodular vascular pattern using two different needle types |
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| Authors: | Dr C Cappelli MD A Tironi MD C Mattanza MD D Cumetti MD B Agosti MD E Gandossi MD I Pirola MD E De Martino MD L Cherubini MD L Micheletti MD M Castellano MD E Agabiti Rosei MD |
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| Institution: | (1) II Pathological Anatomy, University of Brescia, Italy;(2) Section of Endocrinology c/o 2e Medicina, Spedali Civili di Brescia, Piazzale Spedali Civili no1, of Internal Medicine University of Brescia, 25100 Brescia, Italy |
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| Abstract: | Objective: To compare the cytological findings of hypoechoic thyroid nodules with intranodular vascular pattern (pattern II) obtained
by two different needles (Neolus 25 gauge, Chemil, Wenzhou, China vs Yale Spinal 25 gauge, Becton Dickinson, Madrid, Spain)
in euthyroid patients and to evaluate their cost-effectiveness.
Methods: From January 2001 to December 2003, 480 euthyroid patients with a hypoechoic thyroid nodule pattern II were referred for
US-FNAC. The nodules were alternatively evaluated by Neolus or by Yale Spinal with the stylet (YS+) or without the stylet
(YS−), in order to evaluate if the cytological results could be due to the presence of the stylet or to the different length
of the two needles. For each nodule two passes were performed and the material was obtained by capillary action. Material
was smeared on slides, fixed, and stained by Papanicolaou techniques. Cytological specimens were evaluated in blind by the
same experienced cytopathologist.
Results: Inadequate cytological specimens because of blood contamination were present in 30 (18.7%) samples by Neolus needle and in
22 (13.8%) by YS− compared to only 5 (3.1%) by YS+. In 6 (20%) cases of the 30 repeated US-FNAC by Neolus and in 4 (18%) of
the 22 US-FNAC by YS−, material remained inadequate for diagnosis because of blood contamination. All the five repeated samples
obtained by YS+ became adequate for diagnosis and resulted benign nodules. Direct costs of US-FNAC procedure are currently
Э 72.30 including cytological examination. The cost of Neolus and Yale needles is Э 0.19 and Э 3.0, respectively. The estimated
total cost to obtain a cytological diagnosis by a Neolus needle (160 + 30 repeated US-FNAC) was Э 13809.2 vs Э 12919.5 by
Yale Spinal needle (160 + 5 repeated US-FNAC).
Conclusion: This study demonstrates that the use of Yale Spinal needles greatly reduces inadequate cytological specimens, and therefore
limits both direct and indirect costs. |
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| Keywords: | Fine-needle-aspiration cytology thyroid nodules thyroid ultrasound |
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