Aim: To evaluate local management of thyroid nodules in comparison with the British Thyroid Association guidelines.
Methods: All patients who had fine needle aspiration cytology (FNAC) for a thyroid nodule in 2004 and 2005 were included. Data collected included: patients age, gender, thyroid status, FNA Cytology (including repeats) and THY classification, surgical intervention and histology (if applicable).
Results: 97 patients (82% females, 18% males) were included. A total of 138 FNAC were done after clinical assessment by an ENT surgeon (part of multidisciplinary team). Thyroid function was assessed in 67% of patients, of which 14% were hyperthyroid, 3% hypothyroid and 83% euthyroid. Initial FNAC category was THY1 (21%), THY2 (27%), THY3 (38%), THY4 (10%) and THY5 (4%). Patient with THY1 and THY2 had a repeat FNAC, except for 15% of THY1 and 66% of THY2, who had surgery. THY3-5 all had surgery. In patients who had one FNAC only, 3 patients had histology-confirmed follicular carcinoma of which 2 had follicular lesion and 1 had medullary carcinoma on FNAC report. 12 patients had histology-confirmed papillary carcinoma of which 9 had papillary carcinoma, 1 had follicular lesion and 2 had hurtle cell tumour on FNAC report. In patients with repeat FNAC, 3 had papillary carcinoma histologically of which 1 had hurtle cell tumour and 2 had papillary carcinoma on FNAC report. There was one case of follicular carcinoma consistent with the FNAC result.
Conclusions: A member of the multidisciplinary team dealing with thyroid cancer patients clinically assessed all patients. FNAC was performed subsequently as per guidelines. Assessment of thyroid status needs further improvement. Significant number of patients with THY1 and THY2 on first FNAC report had surgical intervention, negating need for repeat FNAC. Post-operative histology compared accurately with FNAC in almost 100% of follicular carcinoma and 73% of papillary carcinoma.