Reply to Dr. Renshaw

Dear Dr. Bedrossian:We thank Dr. Renshaw for his interest in our article and

appreciate the opportunity to respond. We agree with Dr.Renshaw that we have excellent clinicians at our institution(both endocrinologists and surgeons) and also that our studyincludes highly selected cases, i.e., the ones seen at tertiaryreferral centers. We do not believe that the high number ofnondiagnostic cases in our series is not a problem but inactuality refers to our practice of applying strict adequacycriteria to interpretation of thyroid FNA, which is one of themajor reasons for false-negative thyroid FNA. In addition,in the majority of cases the slides underwent second reviewbecause the patients were referred to our medical center forsecond opinion regarding diagnosis and treatment. In ourhospital, it is a mandatory practice that all pathology slidesbe reviewed before embarking upon clinical management.

Dr. Renshaw questions the definition of accuracy; itrefers to how correctly a particular laboratory test identifiesa disease process and helps in the proper management of thedisease/s and the patient. The problem with Dr. Renshaw’sdiscussion of accuracy is that it excludes the fact that 16 ofoutside benign, seven of the outside follicular, and oneHurthle cell neoplasm were nondiagnostic. If he wishes tocalculate the accuracy of the outside centers, he would have

to classify these 24 as they were originally classified andthen compare with either the repeat FNA cytology diagnosisor histology (our article does not include this information).Therefore, we believe the “accuracy” calculation for theoutside slides performed by Dr. Renshaw is erroneous. Inaddition, we also strongly disagree that a patient shouldundergo surgery without re-review of their thyroid FNAslides. That implies that all patients with a high clinicalsuspicion of neoplasm, regardless of their FNA diagnosis,should undergo partial or total thyroidectomy; if that is thecase, then one should perilously question if there is a needto perform thyroid FNA. We do not believe this is the case;even with our indeterminate diagnosis in thyroid FNA, themajority of clinicians still believe that thyroid FNA is anessential management tool in the modern approach to thy-roid nodules.

Zubair Baloch, M.D., Ph.D.

Prabodh K. Gupta, M.D.

Susan Mandel, M.D.

Virginia A. LiVolsi, M.D.

University of Pennsylvania School of MedicineHospital of the University of PennsylvaniaPhiladelphia, PA

Published online in Wiley InterScience (www.interscience.wiley.com).DOI 10.1002/dc.10137

130 Diagnostic Cytopathology, Vol 27, No 2 © 2002 WILEY-LISS, INC.