Quality improvement by standardization of procurement and processing of thyroid fine-needle aspirates in the absence of on-site cytological evaluation

Background: Thyroid nodules are relatively common and are routinely evaluated by fine-needle aspiration cytology, usually performed by clinicians. We noticed qualitative and/or quantitative variability in samples submitted to the cytopathology laboratory from clinicians, for example, the number of glass slides submitted (2-25) and air-dried smears versus alcohol-fixed slides, with variability in specimen adequacy and interpretability. The objective of this study was to standardize the preanalytic variables to determine if there is an improvement in the specimen quality. Methods: We standardized the method of collection (ultrasound-guided, 25-gauge needle, four passes) and preparation of samples (four total smears: two air-dried, two fixed, with liquid-based preparation and/or cell block) and personnel involved. Results: Standardization of thyroid nodule fine-needle aspiration and sample preparation by clinical staff resulted in an overall improvement in the quality of sample (odds ratio=3.82, 95% confidence interval 2.02-7.24, p<0.0001) with an increased proportion of satisfactory samples from 67% prestandardization to 89% poststandardization. Conclusions: Standardization resulted in a significant improvement in specimen interpretability.