Numerous studies in the past have shown notable discrepancies in initial diagnosis and review of histopathological slides. This is important as it guides the surgeons whether observation vs surgery, and what type, is required.

The aim of this study is to report variability amongst different pathologist from different institutions in the Middle east region. This study is looking at the thyroid database in Cleveland Clinic Abu Dhabi (CCAD) from January 2021 to November 2023 and reviewing all external FNA(Fine needle aspirate) slides. They were reviewed by internal pathologists and the diagnosis was re-evaluated either agreeing or disagreeing using the Bethesda system. Slides were looked at per nodule examined and not per number of patients since some patients had 2-3 nodules sampled at a given time.

Total of 329 nodules were looked at out of which 144 were discrepant nodules. 121 (84%) of the nodules were downgraded from the initial reporting after internal review of the slides. The majority, 63 (52%) were downgraded from Bethesda 3 to a Bethesda 2. 23 (16%) were upgraded from the initial diagnosis. 14 (60%) of the nodules were upgraded from a nodule from suspicious, Bethesda 5, to positive for malignancy, Bethesda 6.

This study aims to share awareness about the importance of re-evaluating external slides instead of repeating the FNA for each patient in house. Review of slides should be mandatory as this will have a great impact on surgical planning, cost effectiveness of not repeating FNA and potentially avoiding surgery altogether.