Endocrine Abstracts

Objective: Guidelines recommend using fine needle aspiration cytology (FNAC) to guide thyroid nodule surgical indication, however to what extent these guidelines are followed remains unclear. This study aimed to analyze the quality of the preoperative care pathway and the influence of the care pathway on surgical indications relevance.

Design: Nationwide historical cohort study based on data from a sample (1/97th) of French health insurance beneficiaries.

Methods: Evaluation of the care pathway of adult patients operated between 2012 and 2015 during the year preceding thyroid nodule surgery. Pathways containing a FNAC were called ‘FNAC’ or ‘FNAC + ENDO’ when including an endocrinology consultation; whereasthe no FNAC pathway was called ‘NO FNAC’. The main outcome was the malignant nature of the nodule.

Results: Among the 1080 patients included in the study, ‘FNAC + ENDO’ was found in 197 (18.2%) patients, ‘FNAC’in 207 (19.2%) and ‘NO FNAC’ in 676 (62.6%).A cancer diagnosis was recorded in 72 (36.5%) ‘FNAC + ENDO’ patients and 66 (31.9%) ‘FNAC’ patients, against 119 (17.6%) ‘NO FNAC’ patients. As compared to ‘NO FNAC’, ‘FNAC + ENDO’ care pathway was significantly associated with thyroid cancer diagnosis (OR 2.67; 95% CI 1.88–3.81; P-value <0.001) as was’FNAC’ (OR 2.09; 95% CI 1.46–2.98; P-value <0.001). Surgeries performed in university hospitals were significantly associated with thyroid cancer diagnosis (OR 1.61; 95% CI 1.19–2.17; P-value = 0.002).

Conclusions: Guideline compliancewas insufficient but was associated with more relevant surgical indications. A trend towards improvement in compliance with guidelines was observed over the years.