7929 Immediate Read Telecytopathology Improves Diagnostic Rates Without Altering Indeterminate Rates for Thyroid Nodule Biopsy

Abstract Disclosure: W.E. Lanik: None. A. Fingeret: None. B. Rose: None. A. Kotwal: None. A. Yuil-Valdes: None. A. Patel: None. W.S. Goldner: None. Introduction: Ultrasound-guided fine-needle aspiration (FNA) is the preferred biopsy method for evaluation of thyroid nodules. Non-diagnostic and indeterminate biopsies impact patient care and healthcare cost. Rapid on-site evaluation (ROSE) seeks to alleviate this burden and involves evaluation of thyroid material at the time of biopsy. ROSE improves FNA adequacy rates. In our retrospective study, we sought to determine if the adaption of ROSE + telecytopathology (ROSE/T) increased diagnostic biopsies and reduced rates of Bethesda III and IV. Methods: A retrospective analysis of 3,310 ultrasound-guided thyroid FNAs including no ROSE, ROSE, or ROSE/T from 2018 to 2022 was performed. When utilizing ROSE, thyroid biopsy specimens were assessed using conventional microscopy and interpreted by a cytotechnologist while ROSE/T utilized a synchronous audiovisual communication with a remote cytopathologist. Biopsy results were reported using the Bethesda classification system for reporting thyroid cytology. Non-diagnostic vs diagnostic rates and indeterminate rates (Bethesda III and IV) vs Bethesda II, V, and VI were analyzed. Results: Of the 3,310 cases, 275 (8.31%) were Bethesda I. There were 2,242 (67.73%) Bethesda II, 394 (11.90%) Bethesda III, 208 (6.28%) Bethesda IV, 80 (2.42%) Bethesda V, and 111 (3.35%) Bethesda VI. Distribution of cases was 314 (9.49%) without ROSE, 1,570 (47.43%) ROSE, and 1,426 (43.08%) ROSE/T. Non-diagnostic rates without ROSE were significantly higher at 43 (13.69%) vs ROSE and ROSE/T (p=0.0008), while no difference in diagnostic rates was observed between ROSE 129 (8.22%) and ROSE/T 103 (7.22%) (p=0.012). Indeterminate rates were 49 (18.08%) without ROSE, 262 (18.18%) with ROSE, and 291 (22.0%) with ROSE/T. Overall diagnostic FNAs significantly increased over time (p=0.0063), however there was no trend detected in indeterminate biopsies over time (p=0.1176). Discussion: Both types of ROSE allow for immediate feedback to the practitioner leading to further passes and increased diagnostic rates. The trend of diagnostic biopsies represents the increasing adoption of ROSE/T over time. Indeterminate rates were higher with ROSE/T, despite no increase in the indeterminate trend over time. These findings could represent the influence of academic dialogue between physicians at the time of biopsy p