Journal
AMERICAN JOURNAL OF CLINICAL PATHOLOGY
Volume 138, Issue 6, Pages 823-830Publisher
OXFORD UNIV PRESS INC
DOI: 10.1309/AJCP8BYTCFI0XJZU
Keywords
Fine-needle aspiration (FNA); Sampling; Simulation; Modeling; Adequacy; Adverse events; Comparative-effectiveness analysis
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Sample adequacy is an important aspect of overall fine-needle aspiration cytology (FNAC) performance. FNAC effectiveness is augmented by an increasing number of needle passes, but increased needle passes are associated with higher costs and greater risk of adverse events. The objective of this study was to compare the impact of several different sampling policies on FNAC effectiveness and adverse event rates using discrete event simulation. We compared 8 different sampling policies in 12 different sampling environments. All sampling policies were effective when the per-pass accuracy is high (>80%). Rapid on-site evaluation (ROSE) improves FNAC effectiveness when the per-pass adequacy rate is low. ROSE is unlikely to be cost-effective in sampling environments in which the per-pass adequacy is high. Alternative ROSE assessors (eg, cytotechnologists) may be a cost-effective alternative to pathologists when the per-pass adequacy rate is moderate (60%-80%) or when the number of needle passes is limited.
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