Endocrine Abstracts

Aim: Investigation of thyroid nodules usually involves an ultrasound and fine needle aspiration (FNA); however it could still be challenging to devise a management plan based on these. The aim of our study was to compare the reliability of two thyroid FNA’s and ultrasound in comparison to post-operative histology in managing thyroid nodules.

Methods: The data on patients who had underwent thyroidectomy and had at least two FNAs and Ultrasound pre-operatively were analysed. Patients who had ultrasound done prior to the introduction of ‘U’ staging were excluded. Patients with a history of hyperthyroidism were excluded. Post-operative histology was used as gold-standard, FNA and ultrasound results were compared. Results of sixteen patients were analysed.

Results: • Malignant on histology (n=5): Ultrasound was reported as U2 (benign) in two of these patients and correctly identified malignancy in 60% of patients. FNA during the first attempt identified just one patient as Thy 3f, all others were reported as Thy 1. Repeat FNA confirmed cytology of Thy 3 or higher. Cytology correctly identified malignancy in 25% of cases on first attempt and 100% on second attempt.

• Benign on histology: (n=11): Ultrasound confirmed nine of the eleven nodules as U2. A patient with follicular adenoma was reported as U3 (suspicious) on ultrasound and was noted to have THY1 on two separate cytology samples. Another patient with U4 findings on ultrasound was found to have THY3A/THY2 on cytology. Histology subsequently revealed a hyperplastic nodule in multi nodular goitre with no malignancy.

Conclusions: Isolated ultrasound imaging is insufficient to exclude thyroid malignancy. In our small sample, cytology on second attempt was superior to ultrasound on detecting malignancy. Combination of both ultrasound and FNA is needed along with a MDT approach for management of thyroid nodules.