Fine needle aspiration biopsy (FNAB) is the investigation of choice for patients with thyroid nodules in secondary care. Ideally the following standards should be met: assessment within 2 weeks of referral; FNAB performed in the first visit; consent obtained and documented; communication of the result in person.
A cohort of 64consecutive patients (57 female) was identified. The median age was 49 (16-78). Thyroid function tests were normal in 89% of patients .The median time from referral to new appointment was 19 days (4 days-2 months). FNAB was performed in the first visit in 40 patients (63%). The nodule was impalpable in 20 patients (31%) and an FNA was performed under ultrasound guidance in 4 patients (6%); the remaining 16 patients either had simple goitres or another thyroid diagnosis, which was judged not to warrant FNAB. Verbal consent was clearly documented in the medical records in 12 patients (30%).
81% of FNABs yielded sufficient cells for diagnosis of which 71% were benign; 17% showed follicular neoplasm and underwent a thyroid lobectomy; of these 12% were follicular adenomas and 5% benign colloid nodules. Only 2 cases (4%) were malignant, one a follicular carcinoma and the other a non-Hodgkin's lymphoma. Only 56% of the FNAB results were communicated at a clinic visit while 44% either by letter or telephone.
This audit has identified significant shortfalls in the management of thyroid nodules, particularly in communicating results to patients. Additional resources are necessary in order to meet government standards.