Introduction: Thyroid nodules have a prevalence of 50% in the adult population in the UK. The risk of cancer is significantly lower if the nodules are a part of multi-nodular goitre. Fine needle aspiration and cytology (FNAC) is an important tool to assess the risk of malignancy in thyroid nodules.
Method: We audited the safety and efficacy of management of thyroid nodules at Bolton in accordance with British Thyroid Association and Royal College of Pathologists guidelines. Data of 30 consecutive patients were collected from their case notes, radiology results and lab results and then analysed. All data expressed as Mean (S.D.).
Results: The mean age of the patients was 53.4 (17.5) years. 83.3% were females. Thyroid function tests were checked in all patients. 83% of initial FNACs were performed by ENT surgeons without US guidance and 17% performed by Radiologists were with US guidance. Out of the initial FNACs, Thy1-46%, Thy1c-17%, Thy2-27%, Thy2c-0, Thy3-7% and pus aspirated from a nodule in 1 case (3%). FNAC was repeated by Radiologists in 4 and ENT surgeons in 13 cases with similar US support. The results after the second FNAC were Thy1-47%, Thy1c-12% and Thy2-41%. 14 (47%) cases were discharged after 1st or 2nd FNAC results. Among the rest, 1 was too ill for surgical intervention and 2 went to the independent sector for their surgery. Amongst the rest, 2 underwent total thyroidectomy and one of them had Hurthle cell cancer. Out of the 11 who underwent hemithyroidectomy, one was found to have papillary thyroid carcinoma.
Conclusions: The overall pickup rate of cancer was 7.4% of all patients who had undergone FNACs in our cohort of patients audited. We may be able to refine our diagnosis and reduce surgery if all 2nd FNACs were performed under US guidance.