Fri, 11/8: 4:15 PM - 4:30 PM
The Bethesda System for Reporting Thyroid Cytopathology recommends an "Atypia of Undetermined Significance" (AUS) rate of 10% or less. In the past, our institution has consistently exceeded this benchmark, prompting an in-depth Quality Improvement (QI) initiative in 2023. This initiative focused on analyzing patterns of AUS usage among pathologists and correlating these with molecular test results (MRT) to identify potential AUS overuse. Feedback on AUS rates was subsequently provided to pathologists and intradepartmental second opinions for AUS cases were encouraged. The present study evaluates the impact of this QI initiative on AUS rates one year later.
Board-certified cytopathologists were labeled P1 through P5. The proportion of diagnoses across Bethesda categories was calculated for each pathologist (Table 1). Comparative analysis of AUS usage among 5 pathologists was conducted, spanning the years 2021-2022 and focusing on changes in 2023 (one year post QI project) (Figure 1). We also evaluated the use of intradepartmental second reviews for AUS cases.
An in-depth laboratory-wide QI initiative that focused on thyroid AUS rates and included molecular testing correlation, feedback to pathologists, and intradepartmental consultation has proven beneficial for lowering our AUS rates. Further investigation of AUS subcategories (nuclear; other) and impact on the other diagnostic categories is ongoing.
AUS usage decreased significantly in 2023 (16.9%) compared to the combined 2021-2022 period (22.6%), with a relative risk reduction (RRR) of 25.2%. This decrease was statistically significant (chi-square test, p<0.05). P1 (10.4% in 2023 versus 18.4% in 2021-2022, RRR of 43%) and P5 (15.4% in 2023 versus 28% in 2021-2022, RRR of 45%) also showed significant decreases in AUS usage (chi-square test, p<0.05). These two pathologists combined reviewed 52.2% of their AUS cases with at least one other colleague in 2023, compared to 33% of total AUS cases.
Co-Presenter(s)
Jonathan Marotti, MD, Dartmouth Hitchcock Medical Center
Xiaoying Liu, MD, MS, FIAC, Dartmouth Hitchcock Medical Center
Presenter
Abdol Aziz Ould Ismail, MD, Dartmouth Hitchcock Medical Center
Presentation Category
Quality Assurance + Patient Safety