The impact of cytopathologist-performed rapid on-site evaluation on the diagnostic adequacy of thyroid fine-needle aspiration

INTRODUCTION: Rapid on-site evaluation (ROSE) is thought to increase the adequacy of thyroid fine-needle aspiration (FNA) biopsiesand reduce overall cost. MATERIAL AND METHODS: We conducted a retrospective review of thyroid FNA cases from patients who presented to the endocrinology outpatient clinic of a tertiary center between May 2018 and March 2023. A cytopathologist performing ROSE in an FNA room in the endocrinologyclinic was available during the period June 2019-March 2023. Between May 2018 and June 2019, ROSE was not available. RESULTS: Of 1614 FNAs, 1212 were performed with ROSE by a cytopathologist and 402 without ROSE. The number of nondiagnostic FNA cases was 297 (24.6%) with ROSE and 140 (34.8%) without ROSE. In Group A (with ROSE), a total of 94 of 1212 nodules underwent repeatbiopsy, corresponding to a rate of 7.75%. In Group B (without ROSE), 59 of 402 nodules required repeat biopsy, yielding a rate of 14.7%. CONCLUSIONS: Although cytopathologist assistance during thyroid FNA increases costs, it lowers insufficiency rates by reducing the need for repeat procedures and expedites the time to definitive diagnosis.