Endocrine Abstracts

Introduction: This audit aims to evidence the compliance of our practice with guidelines on the management of thyroid cancer. This may help to promote quality improvement in areas where there is substandard clinical care and service provision.

Method: In this retrospective study, patients diagnosed with thyroid cancers at our unit between 2009 and 2014 were identified. Electronic records were examined to establish the dates of referral, clinic attendance, investigations, and treatment, allowing us to determine whether patients received timely assessment and treatment. The quality of our ultrasound reporting and inadequacies of cytological assessment were also documented. A comparison was made against standards as proposed by the British Thyroid Association.

Results: There were 37 cases of thyroid cancer. 18 patients presented with a symptomatic thyroid nodule, five as incidental radiological findings and 14 as incidental pathological findings. Of the 23 cases with suspicious thyroid nodules, 11 were not seen in clinic within 2 weeks of referral and eight did not have first definitive treatment within 62 days. The mean time to their diagnostic fine-needle aspiration (FNA) was 32 days. Of the 30 ultrasound scans completed, 23 were performed prior to Endocrine Clinic. However, none of these reports included all suggested features for risk stratifying thyroid nodules. Of the 41 FNA performed, 12 yielded inadequate specimens. The mean time to a repeat FNA was 104 days.

Conclusion: There was a considerable proportion of inadequate FNA specimens and thyroid nodules were poorly classified on ultrasound reporting. This may be why there was a significant lag period to a diagnostic FNA with subsequent delays to management. We recommend ultrasound assessment for risk stratification of all thyroid nodules and that this is clearly reported. In addition, any inadequate specimens should have a repeat FNA urgently under ultrasound guidance.