Fine needle aspiration adequacy in a one-stop neck lump clinic: 2nd cycle improvement

The one-stop neck lump clinic at Warrington Hospital was established in 2011 in line with NICE head and neck cancer guidelines.1 They recommend that fine needle aspiration (FNA) is performed under ultrasound guidance in the presence of an onsite cytopathologist. This enables an immediate assessment of adequacy and repeat sampling as required on the same day to prevent diagnostic delay.2 The Royal College of Radiologists recommend a minimum adequacy rate of 70% for thyroid lesions. In 2014, a systematic review of 78 papers found an average FNA adequacy rate for all head and neck lesions of 90.7%.3 Methods: This re-audit aimed to evaluate whether local recommendations for improving the performance of ultrasound. Data collected retrospectively between August 2017 and January 2018 were compared to the first cycle audit (December 2015 May 2016). The adequacy of initial FNA samples were recorded and whether repeat aspirations were required. Samples were considered inadequate if the cytology report stated insufficient material for adequate diagnosis.4 The reasons for diagnostically inconclusive reports were documented. Results: FNA cytology reports for 62 patients (53% female) in the second cycle were compared to 56 patients (64% female) in the first cycle. All pathologies were included, except for patients with suspected lymphoma.The adequacy rate for initial FNA reports increased from 76% to 89%. The specific adequacy rates for thyroids, salivary glands and lymph nodes improved by 18%, 18% and 4% respectively Conclusion: Discussion with the local pathology and radiology departments after the initial audit generated recommendations to improve adequacy rates. The introduction of CytoRich fluid for thyroid specimen preparation significantly increased adequacy. Narrower bore needles reduce the risk of haemorrhagic samples and were used for repeat FNA sampling to successfully decrease inadequate reports.