FNA practice, variability, and a renal FNA review
Experts stressed that high‑quality smears and ROSE are essential for pancreatic and other FNAs, a Cancer Cytopathology systematic review called for standardized classification for renal FNA, and an AI analysis found consensus on 'suspicious for malignancy' in hypercellular thyroid FNAs but marked divergence on subtyping (Hürthle vs medullary). The trio underlines both technique and reporting standard gaps across aspirates. ( )
Cancer Cytopathology published a systematic review (Katipoglu et al., 2024) that pooled 23 studies and 2,231 renal FNA cases to test a proposed standardized renal‑FNA reporting scheme. (acsjournals.onlinelibrary.wiley.com) The review reclassified cases into categories and reported category‑specific risks of malignancy ranging from ~16.6% for benign neoplasm to 96.9% for malignant diagnoses, with a 73.3% ROM for “suspicious for malignancy,” and overall scenario accuracy estimated at 91%–95%. (acsjournals.onlinelibrary.wiley.com) Historical meta‑analyses found ROSE and high‑quality smear techniques increased EUS‑FNA diagnostic yield by roughly 10–30% in many series, but a multicenter randomized noninferiority trial and subsequent analyses reported EUS‑FNB without ROSE achieved diagnostic accuracy up to 97% in experienced centers, prompting recommendations to reconsider routine ROSE where FNB is available. (journals.plos.org) (gastroenterologyadvisor.com) Deep‑learning work on thyroid FNAs showed very high PR‑AUCs (>0.95) for many classes but substantially lower performance for poorly differentiated tumors (PR‑AUC 0.49) and variable recall for medullary patterns (PR‑AUC ≈0.91), while cytology literature documents persistent interobserver variability for oncocytic (Hürthle) lesions and case reports show oncocytic medullary carcinoma can mimic Hürthle lesions on FNA. (acsjournals.onlinelibrary.wiley.com) (frontiersin.org) (europepmc.org) Operationally, the renal‑FNA review’s category‑specific ROMs and the randomized FNB data together imply laboratories will need local correlation audits (histologic follow‑up counts, per‑category ROM tracking) and reassessment of on‑site staffing models if switching to FNB; the review explicitly proposes a new reporting system to reduce indeterminate calls and guide management thresholds. (acsjournals.onlinelibrary.wiley.com) (practiceupdate.com)
