Endocrine Abstracts

Introduction: BTA guidelines-2014 outlined the need for key features to be included in thyroid ultrasound scan (USS) reporting including risk stratification. The aim of this audit was to evaluate the quality of thyroid-USS reporting at Northumbria Healthcare NHS Foundation Trust (NHCT); using BTA guidelines as the gold standard.

Methods: All thyroid/neck-USS between 1st November to 31st December 2015 were retrieved from radiology records at NHCT. Scans evaluating salivary glands, posterior neck, lipomas, and scans in patients <18 years old were excluded. Twelve domains were assessed and outcome compared to a pre-guidelines audit (2013). Fine needle aspiration cytology (FNAC) data was correlated to U-grading.

Results: 134 of 256 scans identified were included. Nodules were identified in 104 scans (77%). Nodule size, lymph nodes and U-grading were reported in 89%, 72% and 67% of cases respectively. Scans were performed by 23 different sonographers and quality of reporting varied widely. Majority of nodules were graded U3 (50%) or U2 (43%). FNAC in those with U3 grading yielded 38% Thy1, 21% Thy2, 11% Thy3, 3% Thy4, and 3% Thy5; with 24% (n=9) having had no FNA done at the time of audit. Repeat USS and FNAC in those with Thy1 cytology resulted in 12% Thy1, 30% Thy2, 6% Thy3, while 35% were still awaiting repeat FNAC. In 18%, rescanning downgraded the nodules to U2. There was a significant improvement in overall reporting quality compared to the earlier audit, specifically with regards to risk stratification using U-grading (70% vs 37%) and lymph node evaluation (93% vs 27%).

Conclusions: Significant improvement in reporting quality has been achieved after introduction of BTA guidelines, however there remains room for improvement. Thy1 yield remains an issue. Majority of U3-graded nodules were benign on FNAC report. Further training for sonographers is needed in order to improve reporting outcomes.