Endocrine Abstracts

Introduction: Fine needle aspiration (FNA) is used, in conjunction with clinical assessment and imaging, to assess thyroid nodules for suspected malignancy. Cytological assessment of FNA samples involves both a text report and classification into a diagnostic category Thy1–Thy 5. The cytological category Thy 2 describes a FNA sample assessed to be non-neoplastic. Current BTA guidelines recommend two FNA samples, 3–6 months apart, are obtained to exclude neoplasia.

Objective: To assess the management decisions taken following a single FNA sample reported as non-neoplastic (Thy 2) and the frequency with which FNA sampling is repeated within 3–6 months following a Thy 2 result.

Method: Retrospective audit was conducted reviewing all FNA samples obtained over a one year period at a teaching hospital. Samples classified as Thy 2 were identified. The subsequent management plans for the patient were reviewed. An assessment was made of the risk factors and suspicious clinical and radiological features present in each case. Assessment was made of whether the management plan was fully enacted and any other clinical outcomes.

Results: Forty-five FNAs reported as Thy 2 were included in the analysis. Seven cases (16%) were recommended to have a repeat FNA sample. In 28 cases (62%), a decision was taken, not to repeat the FNA, but to either discharge or follow up with clinical or radiological assessment. Seven cases (16%) were recommended to have surgery despite the benign FNA result. Three cases had a previous benign FNA sample, and repeat aspiration was not indicated.

Conclusion: Only 16% of cases were recommended to have repeat FNA performed following clinical assessment and an initial benign FNA result. This demonstrates that some multidisciplinary teams feel confident to decide on definitive management without repeat FNA. Long term follow up will be required to determine the safety of this clinical approach.