1. A comparative audit of FNA Thyroid results with use of Spinal needle
University Hospital Limerick
T Kelly, C O’Rourke, T Scanlon, J O’Brien, P Kiely, J.E Fenton

2. Background
Prior 2014
After 2014

3. Background Does the needle type really matter?
Thinner needles (24-25G)
Length of needle makes no difference
Capillary action technique > aspiration
Recent research states spinal needles > traditional needle

4. Background Spinal needles More expensive (€1-3 vs €0.05)
Reduce inadequate cytological specimens due to use of stylet
Comparison of inadequate specimen rates
Blue needle = 18.7%
Spinal w/o stylet = 13.8%
Spinal w stylet = 3.1%
Cappelli et al. Cost-effectiveness of fine-needle-aspiration cytology of thyroid nodules with intranodular vascular pattern using two different needle types. Endocr Pathol Winter; 16(4):349-54

5. Introduction
The aim of this study was to analyze FNAC results of thyroid nodules using 22G Spinal Needle
Compare FNAC results with those using a traditional needle

6. Methods Comparative audit of all FNA thyroid samples
January – June 2014 (6 months)
3 consultant radiologists
All using spinal needle
22G Spinocan (stylet)
Ultrasound scanner
Philips iU22

7. Methods
Examined
Patient demographics
Cytology
Morphology
Ultrasound report
All results compared with previous years, using standard 23G blue needle.

8. Methods Technique Small variations between radiologists
All use Local Anaesthetic
2-3 Needles used per nodule
Capillary action used
All use stylet

9. Results Total 91 patients Demographics Sex Age 100 nodules sampled
Male – 14 (15%)
Female – 77 (85%)
Ratio 1:5
Age
Range – 85 years
Median – 55 years

10. Results

11. Results

12. Radiologist 1 Mean size of inadequate samples = 2.52cm
Size (mean and range):
thy cm (1-4.8cm)
thy1c 2.18 cm (1-3.8cm)
thy cm (1-3.9cm)
thy2c 1.75 cm (1.5-2cm)
thy3a 8.5 cm
thy cm ( cm)
Mean size of inadequate samples = 2.52cm
thy1: 2cm, 1.6, 4.8, 1.2, 2.5, 1, 1.2, 4, 1.1, 4.8, 3.8, 4.2 mean 2.68; median between 2 and 2.5
thy2 colloid: 2.4cm, 1, 3.7, 1.8, 2, 2.2, 1, 2.1, 2.3, 1.5
thy2 hyperplastic: 1, 3.4, 3.9, 2.6, 2, 2, 1.5
thy2 cystic degeneration: 1.2
thy2 thyroiditis

13. Radiologist 2 Mean size of inadequate samples = 1.87cm
Size (mean and range):
thy1 1.8 cm ( cm)
thy1c 1.98 cm ( cm)
thy2 2.2 cm (0.8-4cm)
thy2c 1.3 cm
thy3f 1.6 cm
thy4 1.8 cm
thy cm ( cm)
Mean size of inadequate samples = 1.87cm
thy2: colloid 1.7cm, 2.8, 2.7, 1.3, 1.4, 1.4, 2.5, 2.8, 2.3, 1.8,
thy2: hyperplastic 2.3cm, 2.3, 2.5, 1.5, 2.5, 1.7, 0.8, 2.5, 3.8, 1.2, 2.4, 4, 2.7, 2.1 (focal Hurtle cell change)

14. Radiologist 3 Mean size of inadequate sample = 3.4cm
Size (mean and range):
thy1c 3.4 cm
thy2 2.1 cm (1.4-4cm)
thy3a 2.25 cm (1.5-3cm)
thy3f 3.5 cm
thy4 3 cm
thy2 colloid: 2, 1.6, 1.7, 1.5, 3
thy2 hyperplastic: 1.8, 2, 1.4, 2.7, 4, 1.5, 2.1

15. Radiologists 1-3

16. Results

17. Results Cost analysis (for 100 samples)
Spinal needle: 100 × €1.50 × 3 = €450
Blue needle: 100 × €0.05 × 3 = €15
Consider repeat FNAC
Current cohort: 87 × €1.50 × 3 = €391.50
(61 THY THY 1)
Total cost (per 100 samples)
Spinal needle = €841.50
Blue needle = €28.05

18. Results
Positive correlation with size of lesion and an inadequate cytology result
Inadequate sample size = 2.5cm
≥ THY 2 = 1.4cm
P < 0.05

19. Discussion Any benefit to use of spinal needle?
Similar rate of inadequate samples with use of blue needle
26% vs 26% THY 1
Extra cost
€1,600 extra cost per year to department

20. Discussion Larger nodules lead to more inadequate results
Mean size THY 1 = 2.5cm
Mean size ≥ THY 2 = 1.6cm
Larger nodules = Greater blood supply

21. Limitations Single institution study Small number of patients
Variability between Radiologists
Large randomised prospective trial required

22. Conclusion
Despite published literature there appears to be no added benefit to the use of spinal needles for FNAC of Thyroid lesions.

23. Thank you Questions?