Enhancing Efficiency and Quality in Thyroid Biopsy: The Long-Term Impact of Implementation of a Program of Dedicated Sonographer-Performed Thyroid Biopsies.
Oct 26, 2026DOI: 10.1016/j.jacr.2026.10.021Journal ArticleJACR
Written by: Sangeet GhaiAnna M SawkaTamar Kass PerelKatherine LajkoszCatherine Tian-Ai TanPamela DaltonDavid P GoldsteinJesse D PasternakLorne E RotsteinKorosh KhaliliXiaoyang LiuCiara O'BrienHyang Mi KoYongheng JiaRudolf BociKulsoom A MaanWasim JavedJoerg Schwock
OBJECTIVE: To evaluate the long-term diagnostic performance and consistency of a dedicated sonographer-performed thyroid FNAB program under radiologist supervision.MATERIALS AND METHODS: This retrospective quality improvement study (QIRC 23-0591) analyzed consecutive thyroid FNABs performed between 2008 and 2022 at a single academic center. A structured sonographer training program was implemented in 2011. Biopsies were categorized into three periods: pre-implementation (2008-April 2011), early post-implementation (August 2011-2013), and late post-implementation (2014-2022). FNABs performed by other clinicians during the late implementation period served as a contemporaneous control group. Outcomes were assessed at the nodule level using the Bethesda System for Reporting Thyroid Cytopathology. Trend analyses were performed using the Cochran-Armitage test; chi-square tests compared groups.RESULTS: A total of 14,127 thyroid nodules were biopsied in the radiology (4,382 pre-implementation; 2,561 early post-implementation; 7,184 late post-implementation period). Nondiagnostic rates decreased from 34% (1492/4382) pre-implementation to 21% (534/2561) early post-implementation and 8.6% (617/7184) late post-implementation period (p<.001). Malignant cytology increased from 4.9% to 5.6% to 7.7%, and combined Bethesda V/VI diagnoses increased from 8.9% to 8.5% to 12.1% (both p<.001). During late post-implementation period, sonographer-performed FNABs demonstrated lower nondiagnostic rates (8.6% vs 29%, p<.001) and higher malignant yield (7.6% vs 4.5%, p<.001) compared with other clinicians. Adoption of ACR TI-RADS in 2020 was not associated with significant changes in adequacy or malignancy rates.CONCLUSIONS: A dedicated sonographer-performed thyroid FNAB program improved diagnostic adequacy and malignancy yield over 11 years, supporting safe delegation of thyroid FNAB to trained physician extenders under radiologist supervision.
