Early FNA training improves residents’ diagnostic skills

Earlier training in fine-needle aspiration (FNA) for radiology residents could improve correct diagnosis using biopsy of the thyroid gland, according to a study published in the August issue of Academic Radiology.

Authors Michael D. Beland, MD, and colleagues of Rhode Island Hospital in Providence, and colleagues wrote that senior residents had a lower non-diagnosis (ND) rate than junior residents, suggesting a need for earlier FNA training.

“Our results support that early and continued performance of even simpler procedures such as thyroid FNA throughout residency training offers improved outcomes,” the authors wrote. “This appears to be particularly true for residents who do not have prior surgical experience or interest in interventional radiology […].”

The study examined 5,418 ultrasound-guided thyroid nodule FNAs from 2004 through 2012 at Rhode Island Hospital. An attending physician supervised more than half (58.4 percent), of the FNAs performed by radiology residents.

Results showed a significant and progressive decrease in the ND rates that correlated with the increased training of senior radiology residents, according to the authors. For example, second-year radiology residents without surgical training had an average ND rate of 18.2 percent, compared with an ND rate of 11.7 percent for fifth-year residents. Second-year residents with surgical training had an ND rate of 14.7 percent, compared with fourth-year residents with surgical training, who had an ND rate of 9.9 percent.

The authors noted that although it is well documented that diagnostic rates can be improved by routine onsite cytopathology, it is costly.

“We do not use routine onsite cytology when performing thyroid FNA, which might have improved the diagnostic yield at all levels,” they wrote.