Endocrine Abstracts

Background: Thyroid nodules are identified in up to 50% of the population, though malignancy risk is 4–7%. The 2014 British Thyroid Association (BTA) guidelines recommend ultrasound U-scoring of nodules to guide fine needle aspiration cytology (FNAC): U1–U2 should not undergo FNAC, whereas U3–U5 should.

Aim: To assess compliance with BTA 2014 guidelines in the reporting and management of thyroid nodules at George Eliot Hospital NHS Trust.

Methods: A retrospective review of 136 thyroid/neck ultrasounds performed over three years was undertaken (2021-2024). Reports were assessed for inclusion of a U-score (or equivalent classification), and cytology outcomes were reviewed to determine whether FNAC was performed appropriately.

Results: The mean patient age was 60.4 years (111 female, 25 male). Thirty-eight had a single nodule and 98 multiple (range 6–60 mm). U-classification was recorded in 115 cases (83%): U2 = 48, U3 = 66, TiRADS = 1; and it was NOT documented in 21 cases (17%). FNAC was booked or performed in 58 cases: Thy1 = 23, Thy2 = 16, Thy3+ = 12; 6 were non-diagnostic, pending, or not completed. Deviations included: 3 U2 nodules referred for FNAC, and 17 U3+ nodules where FNAC was not performed or patient lost to follow up.

Conclusion: The audit identified incomplete U-score documentation and deviations in FNAC practice. Interventions introduced include increasing awareness in staff by departmental and trust based teaching, dissemination of results to relevant department and laminated BTA U-scoring guidance in ultrasound rooms. Re-audit has been planned to evaluate improvement.