Comparison of Cytopathologist-Performed Ultrasound-Guided Fine-Needle Aspiration With Cytopathologist-Performed Palpation-Guided Fine-Needle Aspiration: A Single Institutional Experience
Open accessAbstract
Context.—: Although fine-needle aspiration (FNA) practice by pathologists is now well established, it has been primarily performed by manual palpation. In recent years, pathologists have begun to venture into ultrasound-guided FNAs (UGFNAs). Reports on experiences with this relatively new technique for pathologists have shown promising results. However to date, there have been few studies in the literature comparing pathologist-performed UGFNA with the more traditional pathologist-performed palpation-guided FNA (PGFNA). Objective.—: To compare UGFNA to PGFNA by cytopathologists at an academic medical center. Design.—: A retrospective study of FNAs performed by cytopathologists within the University of California, Los Angeles (UCLA) pathology departmental FNA clinic was performed. Data collected included performance technique (UGFNA versus PGFNA), lesion site and size, adequacy status (nondiagnostic rate), and number of passes per procedure. Corresponding surgical pathology/flow cytometric/cytogenetic result follow-up was compared to FNA results. Findings between UGFNA and PGFNA cases were compared. Results.—: Of 1029 FNA cases during the study period, there were 449 UGFNA cases (43.6%) and 580 PGFNA cases (56.4%). Nondiagnostic rates with UGFNA and PGFNA were 6.7% (30 of 449 cases) and 20.7% (120 of 580 cases), respectively. Nondiagnostic rate was also significantly lower with UGFNA than with PGFNA for lesions within the thyroid (6.0% versus 33.3%), head and neck (6.6% versus 21.2%), and salivary gland (6.2% versus 17.1%), and across all nodule sizes. A total of 495 of 1029 FNA cases (48.1%) had follow-up. Discordance rate was significantly lower with UGFNA than with PGFNA (5.4% versus 12.8%). Conclusions.—: This study shows improved performance characteristics of cytopathologist-performed UGFNA versus PGFNA.
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Addition of ultrasound guidance to FNAB allows visualization of targeted lesions and improves accuracy of sample collection by providing information about adjacent anatomy, vascularity, and heterogeneity of lesions.
“The addition of ultrasound guidance to FNAB not only allows for the visualization of targeted lesions but also improves the accuracy of sample collection by providing information about the adjacent anatomy, vascularity, and heterogeneity of lesions, which helps determine the approach for the biopsy.”
From Fine needle aspiration biopsy in low‐ and <scp>middle‐income</scp> countries (2024) · cites this paper as [46]
When performed specifically by a pathologist, USFNA may yield a higher amount of diagnostic material and lower discordance rates compared to cytopathologist-performed palpation-guided FNAB across various anatomical sites.
“In addition to the general advantages of ultrasoundguided FNAB (USFNA), studies have indicated that when performed specifically by a pathologist, it may yield a higher amount of diagnostic material and lower discordance rates compared to cytopathologistperformed palpation-guided FNAB across various anatomical sites.46”
From Fine needle aspiration biopsy in low‐ and <scp>middle‐income</scp> countries (2024) · cites this paper as [46]
Ultrasound guidance extends the capability to biopsy deeper lesions that may not be easily palpable, expanding the range of lesions that can be sampled.
“Ultrasound guidance also extends the capability to biopsy deeper lesions that may not be easily palpable, thereby expanding the range of lesions that can be sampled for diagnostic purposes.”
From Fine needle aspiration biopsy in low‐ and <scp>middle‐income</scp> countries (2024) · cites this paper as [46]
Cites
Cesur, M., Çorapçıoğlu, D., Bulut, Ş., Gürsoy, A., Yilmaz, A. E., Erdoğan, N., & Kamel, N. (2006) · Thyroid · doi:10.1089/thy.2006.16.555 · Cited by 146 · see citing works
Ultrasound Physics and Instrumentation for Pathologists
Lieu, D. (2010) · Archives of Pathology & Laboratory Medicine · doi:10.5858/2009-0730-ra.1 · Cited by 88 · see citing works
Izquierdo, R., Arekat, M. R., Knudson, P. E., Kartun, K. F., Khurana, K. K., Kort, K. C., & Numann, P. J. (2006) · Endocrine Practice · doi:10.4158/ep.12.6.609 · Cited by 82 · see citing works
Robitschek, J. M., Straub, M., Wirtz, E. D., Klem, C., & Sniezek, J. C. (2010) · Otolaryngology · doi:10.1016/j.otohns.2009.11.011 · Cited by 79 · see citing works
Lieu, D. (2008) · Diagnostic Cytopathology · doi:10.1002/dc.20800 · Cited by 77 · see citing works
Wu, M. (2010) · Diagnostic Cytopathology · doi:10.1002/dc.21460 · Cited by 73 · see citing works
Can, A. S., & Peker, K. R. (2008) · BMC Research Notes · doi:10.1186/1756-0500-1-12 · Cited by 63 · see citing works
Bellevicine, C., Vigliar, E., Malapelle, U., Pisapia, P., Conzo, G., Biondi, B., Vetrani, A., & Troncone, G. (2015) · Cytopathology · doi:10.1111/cyt.12243 · Cited by 59 · see citing works
Ganguly, A., Burnside, G., & Nixon, M. S. (2014) · British Journal of Radiology · doi:10.1259/bjr.20130571 · Cited by 46 · see citing works
The case for pathologist ultrasound-guided fine-needle aspiration biopsy
Abele, J. S. (2008) · Cancer · doi:10.1002/cncr.23950 · Cited by 39 · see citing works
Can, A. S. (2009) · BMC Endocrine Disorders · doi:10.1186/1472-6823-9-14 · Cited by 38 · see citing works
Ultrasound guided FNA of thyroid performed by cytopathologists enhances Bethesda diagnostic value
Wu, M., Choi, Y., Zhang, Z., Si, Q., Salem, F., Szporn, A., Zhang, D., Burstein, D., Teng, M., Miles, B. A., et al. (2016) · Diagnostic Cytopathology · doi:10.1002/dc.23544 · Cited by 27 · see citing works
Starting Out: The Interventional Cytopathologist: A New Clinician/Pathologist Hybrid
Grohs, H. K. (1988) · American Journal of Clinical Pathology · doi:10.1093/ajcp/90.3.351 · Cited by 27 · see citing works
Advances in head and neck fine-needle aspiration and ultrasound technique for the pathologist
Jakowski, J. D., & DiNardo, L. J. (2014) · Seminars in Diagnostic Pathology · doi:10.1053/j.semdp.2014.12.010 · Cited by 15 · see citing works
Dueber, J. C., Pang, J. C., Lew, M., Jing, X., Heider, A., Davenport, R. D., Bernacki, K. D., Kantola, S., & Roh, M. H. (2015) · Journal of the American Society of Cytopathology · doi:10.1016/j.jasc.2014.12.002 · Cited by 14 · see citing works
Breast Imaging for Interventional Pathologists
Lieu, D. (2012) · Archives of Pathology & Laboratory Medicine · doi:10.5858/arpa.2012-0081-ra · Cited by 14 · see citing works
Considerations in incorporating office‐based ultrasound of the head and neck
Akbar, N. A., Bodenner, D., Kim, L. T., Suen, J. Y., & Kokoska, M. S. (2006) · Otolaryngology · doi:10.1016/j.otohns.2006.05.004 · Cited by 13 · see citing works
DiMaggio, P. J., Kutler, D. I., Cohen, M. A., Chen, Z., & Hoda, R. S. (2015) · Journal of the American Society of Cytopathology · doi:10.1016/j.jasc.2015.06.003 · Cited by 11 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Cell-Free HPV DNA Provides an Accurate and Rapid Diagnosis of HPV-Associated Head and Neck Cancer
Siravegna, G., O'Boyle, C. J., Varmeh, S., Queenan, N., Michel, A. G., Stein, J., Thierauf, J., Sadow, P. M., Faquin, W. C., Perry, S. K., et al. (2021) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-21-3151 · Cited by 118 · see citing works
Fine-Needle Aspiration-Based Patient-Derived Cancer Organoids
Vilgelm, A. E., Bergdorf, K. N., Wolf, M. M., Bharti, V., Shattuck-Brandt, R. L., Blevins, A., Jones, C. Y., Phifer, C. J., Lee, M. A., Lowe, C. L., et al. (2020) · iScience · doi:10.1016/j.isci.2020.101408 · Cited by 81 · see citing works
Chambers, M., O’Hern, K., & Kerr, D. A. (2020) · Journal of the American Society of Cytopathology · doi:10.1016/j.jasc.2020.05.012 · Cited by 38 · see citing works
Rivas, H. E. T., Zarra, K. V., Pabón, L. A. P., Gutiérrez, M. D. L. P. G., Ortiz, N. Z., Olmo‐Fernández, M. D. M., Llanos, S. N., Álvarez, N. A., Martín, Á. G., & Fernández, L. (2021) · Acta Cytologica · doi:10.1159/000517314 · Cited by 29 · see citing works
Vergèz, S., Fakhry, N., Cartier, C., Kennel, T., Courtade-Saïdi, M., Uro‐Coste, E., Varoquaux, A. D., Righini, C. A., Malard, O., Mogultay, P., et al. (2020) · European Annals of Otorhinolaryngology Head and Neck Diseases · doi:10.1016/j.anorl.2020.09.002 · Cited by 27 · see citing works
Field, A. S., Raymond, W. A., Rickard, M., & Schmitt, F. C. (2020) · Journal of the American Society of Cytopathology · doi:10.1016/j.jasc.2019.10.004 · Cited by 26 · see citing works
Mazzola, F., Gupta, R., Luk, P. P., Palme, C. E., Clark, J. R., & Low, T.-H. H. (2019) · Head & Neck · doi:10.1002/hed.25732 · Cited by 24 · see citing works
Paolini, F., Campo, F., Iocca, O., Manciocco, V., VIRGILIO, A. D., Pascale, V. D., Moretto, S., Dalfino, G., Vidiri, A., Blandino, G., et al. (2023) · Head & Neck · doi:10.1002/hed.27515 · Cited by 23 · see citing works
Liquid biopsy for the diagnosis of HPV‐associated head and neck cancer
Faden, D. L. (2021) · Cancer Cytopathology · doi:10.1002/cncy.22497 · Cited by 22 · see citing works
Courtade-Saïdi, M., Uro‐Coste, E., Vergèz, S., Vérillaud, B., Dang, N. P., Chabrillac, E., Fakhry, N., Bigorgne, C., & Costes‐Martineau, V. (2023) · European Annals of Otorhinolaryngology Head and Neck Diseases · doi:10.1016/j.anorl.2023.11.002 · Cited by 21 · see citing works
Nacchio, M., Palladino, R., Vigliar, E., Pisapia, P., Salatiello, M., Malapelle, U., Porcelli, T., Luongo, C., Fonderico, F., Masone, S., et al. (2023) · Cancer Cytopathology · doi:10.1002/cncy.22756 · Cited by 15 · see citing works
Head and Neck Squamous Cell Carcinoma of Unknown Primary: A Diagnostic Work-Up
Manoharan, M., Kalman, N. S., & Rabinowits, G. (2023) · The Oncologist · doi:10.1093/oncolo/oyad311 · Cited by 15 · see citing works
Thyroid FNA: Is cytopathologist review of ultrasound features useful?
Renshaw, A. A., Gould, E. W., Russ, G., & Poller, D. N. (2020) · Cancer Cytopathology · doi:10.1002/cncy.22262 · Cited by 15 · see citing works
Preoperative Circulating Tumor HPV DNA and Oropharyngeal Squamous Cell Disease
Lam, D., Sangal, N. R., Aggarwal, A., Rajasekaran, K., Cannady, S. B., Basu, D., Chalian, A. A., Weinstein, G. S., & Brody, R. M. (2024) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2024.0350 · Cited by 14 · see citing works
Harb, J. L., Bakar, D., & Dhingra, J. K. (2020) · OTO Open · doi:10.1177/2473974x20949184 · Cited by 10 · see citing works
Johnson, D. N., Antic, T., Reeves, W. A., Mueller, J. S., Lastra, R. R., Cipriani, N. A., & Biernacka, A. (2021) · Journal of the American Society of Cytopathology · doi:10.1016/j.jasc.2021.03.001 · Cited by 10 · see citing works
Ferreira, F. B. M. D., Puchnick, A., Garcia, D. A. L., Regacini, R., Perez, P. D. T. K., Pinto, M. B. R., Guimarães, J. B., & Fernandes, A. D. R. C. (2022) · Journal of Vascular and Interventional Radiology · doi:10.1016/j.jvir.2022.12.467 · Cited by 10 · see citing works
Laccourreye, O., Gaultier, A.-L., Haroun, F., Lépine, C., Malinvaud, D., & Mirghani, H. (2022) · European Annals of Otorhinolaryngology Head and Neck Diseases · doi:10.1016/j.anorl.2022.04.004 · Cited by 9 · see citing works
Wang, H., Liang, J., Belcher, R. H., Compton, M., Weiss, V. L., Ely, K., Johnson, J. E., & Coogan, A. (2022) · Cancer Cytopathology · doi:10.1002/cncy.22571 · Cited by 9 · see citing works
McKenzie, D. R., Kliassov, E. G., Dash, R. C., Foo, W., Jones, C., & Jiang, X. “. (2022) · Cancer Cytopathology · doi:10.1002/cncy.22590 · Cited by 8 · see citing works
Lynn, T. J., & Monaco, S. E. (2022) · Seminars in Diagnostic Pathology · doi:10.1053/j.semdp.2022.06.007 · Cited by 7 · see citing works
Choy, B., & Ly, A. (2021) · Journal of the American Society of Cytopathology · doi:10.1016/j.jasc.2021.03.002 · Cited by 7 · see citing works
Gimm, O., Ivansson, K., Beka, E., Rossitti, H. M., Garvin, S., & Söderkvist, P. (2021) · The Journal of Pathology Clinical Research · doi:10.1002/cjp2.231 · Cited by 6 · see citing works
Rivas, H. E. T., Fernández, L., Gutiérrez, M. D. L. P. G., Hernández, M. L. B., Fontán, J. F. P., Chandra, A., Caputo, A., Lemos, A. B. D., & Zarra, K. V. (2024) · Cytopathology · doi:10.1111/cyt.13355 · Cited by 6 · see citing works
Jiaxin, W., Zhu, Y., Song, Y., Xu, G., Yu, H., Wang, T., & Zhang, B. (2020) · Gland Surgery · doi:10.21037/gs.2020.03.34 · Cited by 6 · see citing works
Borges, F. A., Camilo‐Júnior, D. J., Yamamoto, F. M., & Xavier‐Júnior, J. C. C. (2022) · Annals of Diagnostic Pathology · doi:10.1016/j.anndiagpath.2022.151912 · Cited by 6 · see citing works
Ciolino, A. L., Anderson, S. R., Gibson, P. C., & Gilbert, M. P. (2020) · Academic Pathology · doi:10.1177/2374289520958171 · Cited by 5 · see citing works
Fine needle aspiration biopsy in low‐ and <scp>middle‐income</scp> countries
Khorsandi, N., Balassanian, R., & Vohra, P. (2024) · Diagnostic Cytopathology · doi:10.1002/dc.25317 · Cited by 4 · see citing works
Gomez, M., Yu, W., & Sneige, N. (2023) · Journal of the American Society of Cytopathology · doi:10.1016/j.jasc.2023.09.001 · Cited by 4 · see citing works
Zarra, K. V., Rivas, H. E. T., Guerrero‐Fretes, N., Olmo‐Fernández, M. D. M., Castañeda-Vozmediano, R., Llanos, S. N., & Nieves‐Alonso, J. (2025) · Cytopathology · doi:10.1111/cyt.13478 · Cited by 3 · see citing works
Wang, H., Liang, J., Borinstein, S. C., Belcher, R. H., Mannion, K., Virgin, F. W., Compton, M., Weiss, V. L., Ely, K., Johnson, J. E., et al. (2022) · Acta Cytologica · doi:10.1159/000522208 · Cited by 2 · see citing works
Kliassov, E. G., McKenzie, D. R., Dash, R. C., Jiang, X. “., Jones, C., & Foo, W. (2022) · Diagnostic Cytopathology · doi:10.1002/dc.25083 · Cited by 2 · see citing works
Wu, M., Vohra, P., Lynn, T., Baloch, Z. W., Balassanian, R., & Kurtycz, D. F. I. (2025) · Journal of the American Society of Cytopathology · doi:10.1016/j.jasc.2025.05.005 · Cited by 2 · see citing works
Ultrasound Guided Biopsy in Patients With HPV‐Associated Oropharyngeal Squamous Cell Carcinoma
Haller, T. J., Abel, K. M. V., Yin, L. X., Lohse, C. M., Douse, D. M., Badaoui, J. N., Price, D. L., Kasperbauer, J. L., & Moore, E. J. (2022) · The Laryngoscope · doi:10.1002/lary.30105 · Cited by 2 · see citing works
Bayrak, B. Y., & Paksoy, N. (2025) · CytoJournal · doi:10.25259/cytojournal_247_2024 · Cited by 1 · see citing works
Neue Aspekte zur Feinnadelpunktion von Lymphknoten
Bode‐Lesniewska, B. (2022) · Der Pathologe · doi:10.1007/s00292-021-01044-2 · Cited by 1 · see citing works
Xu, M., Deng, L., Peng, K., Wei, X., Xie, M., Liu, M., & Peng, H. (2024) · Diagnostic Cytopathology · doi:10.1002/dc.25277 · Cited by 1 · see citing works
Fine-Needle Aspiration and Rapid on-Site Examination (ROSE)
Maleki, Z. (2024) · Springer eBooks · doi:10.1007/978-3-031-67675-8_5 · Cited by 1 · see citing works
Bahrami, A., Soheila, V., Aghamohammadzadeh, N., Najafipour, F., Halimi, M., Javadrashid, R., Jalili, J., & Houshyar, J. (2022) · Immunopathologia Persa · doi:10.34172/ipp.2022.31350 · Cited by 1 · see citing works
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Fakhry, N., Makeieff, M., Nicollas, R., Righini, C. A., & Vergèz, S. (2020) · Elsevier eBooks · doi:10.1016/b978-2-294-77447-8.00023-6
Vergèz, S., Fakhry, N., Cartier, C., Kennel, T., Courtade-Saïdi, M., Uro‐Coste, E., Varoquaux, A. D., Righini, C. A., Malard, O., Mogultay, P., et al. (2021) · Annales françaises d Oto-rhino-laryngologie et de Pathologie Cervico-faciale · doi:10.1016/j.aforl.2020.06.010
Laccourreye, O., Gaultier, A.-L., Haroun, F., Lépine, C., Malinvaud, D., & Mirghani, H. (2022) · Annales françaises d Oto-rhino-laryngologie et de Pathologie Cervico-faciale · doi:10.1016/j.aforl.2022.02.007
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Mukherjee, S., & Bhake, A. S. (2024) · Cureus · doi:10.7759/cureus.54817
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Courtade-Saïdi, M., Uro‐Coste, E., Vergèz, S., Vérillaud, B., Dang, N. P., Chabrillac, E., Fakhry, N., Bigorgne, C., & Costes‐Martineau, V. (2024) · Annales françaises d Oto-rhino-laryngologie et de Pathologie Cervico-faciale · doi:10.1016/j.aforl.2023.06.013
Kurtycz, D. F. I., Baloch, Z. W., Balassanian, R., Lynn, T., Vohra, P., & Wu, M. (2025) · Journal of the American Society of Cytopathology · doi:10.1016/j.jasc.2025.05.001
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Tropiano, P., Rizzo, D., Mele, D. A., Manca, A., Bella, M. A., Deiana, A., Crescio, C., Varrucciu, S., Mureddu, L., Calò, L., et al. (2025) · Acta Otorhinolaryngologica Italica · doi:10.14639/0392-100x-a1057
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- Authors
- Conrad, R., Yang, S.-E., Chang, S., Bhasin, M., Sullivan, P. S., Moatamed, N. A., & Lu, D. Y.
- Affiliations
- Torrance Memorial Medical Center (US)
- Venue
- Archives of Pathology & Laboratory Medicine
- Published
- 2018-04-26
- Volume
- 142
- Issue
- 10
- Pages
- 1260-1267
- ISSN
- 0003-9985 (ISSN-L)
- 1543-2165
- OpenAlex
- W2802239746
- Cited by
- 48
- References
- 18
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 7 · 2023: 5 · 2022: 12 · 2021: 7 · 2020: 9 · 2019: 1
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Archives of Pathology & Laboratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Breast Lesions and Carcinomas
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Cancer Diagnosis and Treatment
- Keywords
- ultrasound-guided fine-needle aspiration, non-diagnostic rate, diagnostic accuracy, thyroid nodules, head and neck lesions, salivary gland lesions
- MeSH terms
- Pathologists, Humans, Palpation, Pathology, Surgical, Ultrasonography, Interventional, Biopsy, Fine-Needle
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