Background: The British Thyroid Associations thyroid cancer guidelines (2014) advocate the U1-5 nodule grading system as a primary diagnostic and classification tool.
Aims: We assessed whether practice reflected guidelines, and examined patient outcomes.
Methods: Patients with a thyroid ultrasound, undertaken by radiographers or general radiologists, in January-June 2015 were identified. Investigation and outcomes over 18 months post-ultrasound were examined.
Results: Thyroid ultrasound was graded in 57 of 60 patients (U2, n=10; U3, n=37; U4, n=6; U5, n=4). Of 10 patients with U2 grading, 3 had fine needle aspiration (FNA), all graded Thy2; of the remainder, one underwent thyroidectomy (benign) and 2 had stable imaging. 32 of 37 patients with U3 grading had FNA: those graded Thy2 (n=15), Thy1 (n=3) and with discordant Thy2/Thy3 on repeated sampling (n=2) had subsequent stable imaging or benign lobectomy; 10 patients with Thy3 underwent lobectomy (malignant (n=5), benign (n=4)) or were downgraded on MDT discussion (n=1); 2 patients with Thy 4/5 FNA had malignancy confirmed. Of 6 patients with U4 grading, radiologist review (locally (n=2), MDT (n=2)) following Thy1/2 biopsy allowed downgrading to U2/U3 in 4 cases, one was a hot nodule and one hemithyroidectomy was benign. Of 4 patients with U5 grading, 2 thyroidectomies identified malignancy, and 2 were benign (on hemithyroidectomy following MDT downgrading to U3 and FNA (n=1) or MDT downgrading to U3 and FNA alone (n=1)). Ultrasound gradings were altered following MDT review in 6 cases, allowing hemithyroidectomy to be avoided in 5 of these. Overall, the 10 patients with confirmed malignancy had initial ultrasound gradings of U3 (n=7), U5 (n=2) and ungraded (n=1).
Conclusion: Almost all patients received graded ultrasound reports, reflecting early guideline adoption. Results support safe discharge for U2 nodules. U3 grading was common, and this will be compared to specialised centres. Regional MDT discussion avoided 5 hemithyroidectomies.