Diagnostic value and cost-effectiveness of on-site evaluation of fine-needle aspiration specimens: Review of 5,688 cases

Fine-needle aspiration (FNA) has proven to be a safe, economical, accurate, and rapid diagnostic technique. A successful FNA requires a specimen with adequate cellularity, high-quality preparation, all experienced aspirator, and cytopathologist. Up to 32% of FNAs in various organs (thyroid, breast, lung, etc.) may be nondiagnostic due to scant cellularity and poor preparation. On-site immediate evaluation of FNA specimens can be beneficial in determination of adequacy: triage for ancillary studies and produce a preliminary diagnosis of the specimen, which often facilitates rapid clinical decisions. In this study, we compared the on-site FNA interpretation with the final diagnosis and calculated its cost benefit. Reports of 5,688 on-site FNA cases from the files of the University of Pennsylvania Medical Center over a 5-yr period (1/1/96-12/31/00) were reviewed. Data of the immediate on-site interpretation and the final diagnosis in each case were compared to determine the diagnostic accuracy, clinical utility, and cost-effectiveness of on-site FNA evaluation. At our institution the average cost per FNA based oil laboratory technical and professional fees ($1,743) and the weighted average cost, based oil utilization, of ancillary laboratory studies ($328) and guidance procedures ($1,025) is $3,096 An additional fee of $231 per case is charged for on-site FNA evaluation bY an attending cytopathologist. The average reported rate of nondiagnostic FNAs without on-site evaluation is 20%. Our own nondiagnostic rate for FNAs with on-site evaluation is 0.98%. If one assumes that patients will undergo a repeat FNA for each nondiagnostic specimen, the estimated additional cost in direct institutional charges is $2,022,626 over 5 yr or $404,525 per yr without on-site evaluation. This potential cost savings would be realized by utilizing on-site evaluation despite the additional fee due to a higher rate of specimen adequacy. Based oil this study, oil-site cytopathologic evaluation of FNA specimens is accurate, cost-effective, and has improved patient care at our institution. (C) 2002 Wiley-Liss, Inc.