Review of Non-diagnostic Thyroid Fine Needle Aspirations Specimens Evaluated by Telecytology Rapid Onsite Evaluations

Summary: Introduction: Telecytology is an innovative solution for rapid onsite evaluations (ROSE). Challenges arise when neither a cytotechnologist nor a cytopathologist is onsite, leading to inaccurate categorization of thyroid fine needle aspirations (FNA) as non-diagnostic (NDX) during ROSE, despite adequate cellularity for diagnosis (SAT) on final review. These discrepancies can result in increased number of passes and longer patient procedures. This study evaluates the causes of these discrepancies to improve our practice. Materials and Methods: A retrospective review of 90 thyroid FNAs performed with ROSE from 1/2016-7/2023 in which the initial adequacy assessment was NDX but final assessment was SAT. The DiffQuik slides were examined. Slide quality characteristics were reviewed by two reviewers, discrepant cases were adjudicated by a third cytopathologist. Data on the telecytology platform used was also collected. Univariate analysis determined associations between variables and incorrect assessments. Results: The use of a robotic microscope with live transmission was associated with an increased likelihood of an incorrect NDX assessment and was close to reaching statistical significance (OR=2.38, p=0.051). Conversely, the presence of obscuring gel (OR=0.43, 95% CI: 0.19-0.97, p=0.041) was more likely to be associated with a correct NDX assessment. Cases with cyst contents (OR=2.01, p=0.14) and cell clusters on the edge of the slide (OR=1.89, p=0.2) appeared to be more likely to be incorrectly assessed as NDX but did not reach statistical significance. The data is summarized in Table 1. Conclusions: The use of a robotic microscope was associated with an increased likelihood of an incorrect NDX assessment during ROSE. In contrast, the presence of obscuring gel was significantly associated a correct NDX assessment. The findings highlight the challenges faced when using a robotic microscope for ROSE of hypocellular specimens and the impact of extraneous material on slide preparation. Therefore, there is a need for continuous quality assurance improvements for telecytology and ROSE for thyroid FNA.