Impact of Cytologist‐Performed Rapid on‐Site Evaluation on Adequacy and Diagnostic Performance in Thyroid Fine Needle Aspiration Cytology
Tülay Koç, Canan Karabulut, Şeyhmus Kaya, İsmail Şalk, Ersin TuncerABSTRACT
Introduction
Rapid on‐site evaluation (ROSE) improves specimen adequacy in thyroid fine‐needle aspiration biopsy (FNAB), but the conventional cytopathologist‐attended model may be difficult to sustain in high‐volume centers. Cytologist‐performed ROSE has been proposed as a practical alternative. This study aimed to evaluate the impact of cytologist‐performed ROSE on specimen adequacy, diagnostic category distribution, number of needle passes, number of prepared slides, and repeat cytology rates in thyroid FNAB.
Methods
We retrospectively compared thyroid FNAB cases performed during two sequential periods at a single institution: a pre‐ROSE period, during which FNAB was performed without on‐site cytological assessment, and a post‐ROSE period, during which ROSE was performed by a cytologist who had completed a structured three‐month training program under the supervision of a pathologist. Specimen adequacy, Bethesda System diagnostic categories, number of needle passes, number of prepared slides, and repeat cytology rates were compared between the two periods.
Results
A total of 916 patients were included, comprising 262 cases in the pre‐ROSE period and 654 cases in the post‐ROSE period. Specimen adequacy increased significantly from 49.2% in the pre‐ROSE period to 85.8% in the post‐ROSE period ( p < 0.001). Bethesda category I diagnoses decreased from 50.4% to 14.8%, whereas Bethesda category II diagnoses increased from 39.7% to 73.5% after ROSE implementation ( p < 0.001). The mean number of needle passes decreased from 3.27 ± 0.49 to 2.12 ± 0.92, and the mean number of prepared slides decreased from 11.86 ± 5.39 to 7.21 ± 3.13 ( p < 0.001 for both). The repeat cytology rate also decreased from 8.8% to 5.2% ( p = 0.043).
Conclusion
Cytologist‐performed ROSE was associated with significantly improved specimen adequacy, a marked reduction in nondiagnostic thyroid aspirates, fewer needle passes and prepared slides, and a lower repeat cytology rate. These findings suggest that a structured cytologist‐performed ROSE model may be a feasible and effective approach for improving specimen adequacy in thyroid FNAB, particularly in high‐volume centers with limited cytopathology resources.