Endocrine Abstracts

Introduction: Ultrasonography is safe, fast and radiation-free. This audit, based on the American Thyroid Association (ATA) Management Guidelines (revised in 2009), aims to establish if our regional unit meets the recommended standards of using ultrasonography to aid the management of thyroid malignancy and to make further suggestions to improve practice.

Methodology: Retrospective data were collected from ultrasound scan reports of patients who had thyroid malignancy in an endocrine unit in the UK. Inclusion criteria: scans between January 2010 and October 2013; histological diagnosis of malignancy. Ultrasound scan results were reported as benign, indeterminate and suspicious of malignancy by experienced ultrasonographers. ATA recommends, ‘thyroid ultrasounography should be performed in all patients with known or suspected thyroid nodules’.

Results: Out of the 100 patients who had a histological diagnosis of thyroid malignancy, 23% was reported to have benign nodules, 32% indeterminate, 39% suspicious of malignancy, 4% not have scans reported and 2% not have scans performed. It is unclear why some ultrasound results were not reported. The two cases that did not have an ultrasound scan done presented with massive thyroid nodules with significant tracheal deviation.

Outcomes: Although only 94% of patients with thyroid nodules had ultrasound scans, one may suspect that the two cases without scan might not have been put through unnecessary investigations due to their clinical presentations highly suggesting a malignancy. A protocol should be established to ensure all scan results were reported to facilitate future references in the management of thyroid malignancy. Moreover, this audit also prompts the revalidation of ultrasonography as a first-line investigation. With the increasing reliability of fine needle aspiration (FNA) in the diagnosis of thyroid nodules, ultrasound scan might not add much extra information to the management. Follow-up study is needed to examine the isolated and combined benefits of ultrasound scan and FNA.