Introduction: In 2014, the British Thyroid Association (BTA) issued guidance on thyroid cancer and introduced a new scoring system for thyroid nodules based on their sonographic appearances (U1-U5). The guidelines specified that nodules with indeterminate or suspicious appearances (U3-U5) should undergo fine needle aspiration (FNA) assessment. This study audits the implementation of the guidelines in our hospital and evaluates any changes in the management of thyroid nodules.
Patients and methods: A list of all the patients undergoing thyroid ultrasound at Chelsea and Westminster Hospital over a 1-year period from January 2016 to December 2016 was obtained. A reference cohort of thyroid ultrasounds performed before the publication of the guidelines (July 2013 to June 2014) was also obtained from the electronic data base. Patients with no nodules and patients aged < 18 years were excluded. The electronic records were used to collect data regarding U classification, FNA cytology, surgery and histopathology results for both groups.
Results: A total of 793 patients were identified: 352 in the pre-guidelines cohort and 441 in the post-guidelines cohort. Patients were matched for age (52±15.8 and 52±16.3 respectively) and gender (1 male: 9 female ratio, in both groups). There was 70% compliance in reporting U grading as per the classification system. Pre-guidelines, 35% (95% CI 0.290.42) of patients had an FNA compared to 22% (95% CI 0.180.27) post-guidelines (P < 0.05). Pre-guidelines, 9% (95% CI 0.060.12) of patients underwent surgery compared to 10% (95% CI 0.070.13) post guidelines (P=0.64). Thyroid cancer was confirmed in 2% (95% CI 0.090.48) of the cases pre-guidelines and in 1.9% (95% CI 0.080.38) of the cases post-guidelines (P=0.86).
Conclusions: Our results have demonstrated a reduction in the number of patients being subjected to FNA with no reduction in the number of surgeries or cancer detection. There were initial challenges in adherence to reporting a U classification and a number of interventions were implemented to increase this.
19 May 2018 - 22 May 2018