Pathologist performed ultrasound guided fine needle aspiration (US-FNA): current status, trends, and insights from the American Society of Cytopathology Sponsored Survey

Introduction: Ultrasound-guided fine-needle aspiration (US-FNA) performed by cytopathologists represents prospects for expanding cytopathology practice. While there is a perceived need for further education and standardization to support future opportunities, this need remains insufficiently documented. The Product Innovation Committee of the American Society of Cytopathology conducted a survey to gather opinions and examine current practices in US-FNA. Materials and methods: An online survey of 32 questions focused on US-FNA practice was open from December 19, 2022, to March 19, 2023, promoted through national and international cytopathology professional societies, using Qualtrics survey software. Results: A total of 216 individuals accessed the survey, with 174 (68% from the USA) successfully completing a qualifying question. Data collected included information on certification, work setting, workload, and years of practice (mean: 16 years, range: 0-50 years). Fifty-nine percent (80/135) were certified in cytopathology by the American Board of Pathology or the International Academy of Cytology. Sixty-three percent (84/134) practiced in academia. Over one-half (70/123) worked in low-volume settings (0-50 US-FNA procedures/year), while 19% worked in medium-to-high volume settings (>300 US-FNA procedures/year). Responses showed variability in diagnostic practices and patient management. Nearly one-half (67/137) of respondents indicated that their pathologists performed US-FNA. Most, but not all, reported following standard procedures, including informed consent, site verification, procedure time-out, and documentation of both the procedure and ultrasound findings. Conclusions: Pathologist performed US-FNA represents an opportunity for growth, but there are significant barriers to adoption including: training, equipment, reimbursement, and procedural variability. This survey stands as an initial step to developing recommendations on best practices.