Nevertheless, there were only 15 minor discordance cases in our study, with no significant difference in minor discordance rates between UGFNA and PGFNA.
On subset analysis in which we excluded the nondiagnostic cases, we found that there remained a trend, albeit no longer statistically significant, toward lower major discordance rate for UGFNA versus PGFNA. This suggests that the differences in discordance rates between the 2 methods are due in part to clinical consequences secondary to reductions in nondiagnostic FNAs with ultrasound.
Areas of FNA that we did not explore but would be beneficial to investigate in future studies include: (1) performance of UGFNA versus PGFNA for obtaining material for ancillary testing, and (2) "costs" of UGFNA versus those of PGFNA.
There is a difference in CPT coding between PGFNA (CPT 10021) and UGFNA (CPT 10022, which should be paired with CPT 76942 for ultrasound guidance of needle placement).
Pathologists, although they are latecomers to this field, are even better suited for the performance of UGFNA; they are already familiar with the performance of traditional PGFNA, subsequent FNA smear preparation, and on-site adequacy assessment.
However, in recent years, increasing numbers of cytopathologists have begun to move beyond palpation-guided FNAs (PGFNAs) and perform ultrasound-guided FNAs (UGFNAs), the latter of which had mainly fallen under the realm of interventional radiologists.
These parameters for UGFNAs were compared to those for PGFNAs. For purposes of follow-up, the corresponding surgical pathology/flow cytometry/cytogenetics cases had to be performed concurrently or within 1 year after the FNA procedure.
A total of 9 of 579 PGFNAs (1.6%) were from the thyroid, compared with 83 of 448 UGFNA cases (18.5%) being from the thyroid (P < .001, [chi square]).
Adequacy rates for PGFNAs and UGFNAs were calculated.