can provide meaningful information to clinicians to initiate therapy without waiting for culture results. FNA PST29 Credentialing Criteria for Pathologists to Obtain Privileges to Perform Ultrasound Guided Fine Needle Aspiration Sara Monaco, MD, Juan Xing, MD, Liron Pantanowitz, MD. University of Pittsburgh Medical Center, Pittsburgh, PA Introduction: Many cytology laboratories have started offering pathologist performed ultrasound guided fine needle aspirations (USG FNA). When bringing on an USG FNA service, many aspects need to be addressed including purchasing of ultrasound equipment, developing a business plan, certification and training. There is little guidance for pathologists on how best to obtain privileges at their institution to perform these procedures. We report the criteria employed at our institution permitting pathologists to perform USG FNA. Materials and Methods: A multidisciplinary team was assembled at our hospital including cytopathologists, chief of pathology, chief of medical staff, and head of radiology. Acceptable criteria were determined by this group in order to increase the clinical privileges of pathologists allowing them to perform USG FNA. Results: The following criteria were utilized: (1) board certification in cytopathology with experience in FNA, (2) successfully completing an accredited course/training program in USG FNA (e.g. College of American Pathologists course), (3) undertaking 20 USG FNA procedures, followed by a focused performance evaluation by the director of cytopathology documenting specimen adequacy and complication rate, and (4) submission (of 1-3 above) for approval by the credentials committee of the hospital medical staff, and if deemed necessary, an extradepartmental review by another department (e.g. radiology). Conclusion: Developing acceptable medical staff criteria at our institution permitting pathologists to do USG FNA has helped promote the adoption of our service. Formalizing this process also had indirect benefits such as minimizing political conflict with other clinicians who perform USG FNA, improving quality assurance, and possible medicolegal consequences. PST30 Impact of Pathologist-Performed Ultrasound-Guided Fine Needle Aspirations in a Tertiary Care Academic Center Adam Gomez, MD, David Levy, MD, Christina Kong, MD, Steven Long, MD. Stanford Hospital and Clinics, Stanford, CA Introduction: Pathologist-performed ultrasound-guided fine needle aspira- tion (US-FNA) allows for targeted sampling of non-palpable lesions with the additional advantages of immediate evaluation for adequacy, preliminary diagnosis, and the ability to triage the specimen for ancillary testing. In this study, we evaluate our experience with US-FNA and the impact of adding US-guidance to our well-established on-call pathologist- performed FNA service. Materials and Methods: We queried our pathology database for FNAs performed between December 2012 and March 2015, then identified pathologist-performed cases with Current Procedural Terminology (CPT) codes 10021 (FNA without imaging guidance) and 10022 (US-FNA). For all pathologist-performed US-FNA, we performed a retrospective review of lesion location and final pathologic diagnosis. Results: 2,178 of 8,953 FNA cases (24%) were performed by pathologists from January 2012 to March 2015. Of these, 593 (27%) were US-FNA corresponding to 680 separate sites. The rate of pathologist-performed US- FNA increased from less than 1% in 2012 to over 40% by 2014 (Table 1) while the volume of pathologist-performed FNAs increased 50% and overall FNA volume increased 17%. Table 2 shows the variety of locations sampled over this time period with corresponding examples of final pathologic diagnoses. Conclusions: Since the introduction of US-guidance to our FNA service, the overall volume of FNAs has increased by 17%. A significant portion of this growth can be attributed to the introduction of pathologist-performed US-FNA which has been embraced at our institution since it provides same- day access to FNA of non-palpable lesions and streamlines care for oncology patients with recurrent disease. The use of US-guidance has significantly expanded the scope of lesions we can successfully sample and has created a center for training residents and fellows interested in acquiring this new skill. PST31 Applying a Lymph Node Ultrasound Scoring System to Thyroid Ultrasound Guided Fine Needle Aspiration Christopher Metter, MD, Maoxin Wu, MD, PhD. Stony Brook Hospital, Stony Brook, NY Introduction: Liao et al. 2010 observed that certain ultrasound character- istics of lymph nodes could predict malignancy when applied to the equation: 0.06(Age) + 4.76(Short axis/Long axis) + 2.15(Echogenicity pattern) + 1.8(Vascular pattern). This incorporated diagnostic criteria documented in the literature including patient age, shape, and identifying normal lymph node sonographic architecture (hilar echogenicity and vascularity). Liao’s system is highly specific and sensitive when applied to lymph nodes, with malignant nodes scoring >7 and benign nodes <7. Here we investigate the capacity of the equation to predict malignancy in thyroid fine needle aspirations. Materials and Methods: 330 FNA’s from 2014-April 2016 were reviewed. Included were 41 benign lymph nodes, 30 malignant lymph nodes, 90 Bethesda-II thyroid fine needle aspirations, and 12 malignant thyroid fine Table 1 Table 2 Abstracts S15