SFEBES2023 Oral Communications Thyroid (6 abstracts)
Thyroid cancer referral pathways: findings from an inner-city tertiary thyroid centre
Ainesh Singh 1 , Rochan Agha-Jaffar 1 , Jeremy Cox 1 , Gitta Madani 2 , Kunwar Bhatia 2 , Mufaddal Moonim 3 , Florian Wernig 1 , Aimee Di Marco 4 , Fausto Palazzo 4 , Stephen Robinson 1 & Neil Tolley 4,5
1Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom. 2Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom. 3Department of Histopathology, Imperial College Healthcare NHS Trust, London, United Kingdom. 4Hammersmith Endocrine & Thyroid Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom. 5Department of Ear, Nose & Throat, Imperial College Healthcare NHS Trust, London, United Kingdom
Background: Absence of effective clinical indicators for thyroid cancer, which has an excellent prognosis, means community ultrasounds (US) can be important in identifying risk. Where cytology is definitive it should be reviewed by appropriate MDT specialists. This study aimed to examine the outcomes from two-week-wait (2WW) referrals.
Methods: To achieve these aims, we retrospectively reviewed 293 patients referred on the 2ww pathway to an inner-city tertiary thyroid centre (01/09/2021-31/08/2022). Electronic patient records were examined for demographics, US results (highest graded nodule), and cytology.
Results: Following application of exclusion criteria, 262 patients were analysed. The mean (SD) age of the cohort was 49 (±14.7) years: 80.9% (n =212) were female. 12.6% (n =33) had a known multinodular goitre (MNG). The majority were referred on the basis of community US results (49.6%, n =130); 8.5% (n =11) of referrals did not include the scan results. 87.7% (n =114) of these scans were repeated by our thyroid MDT radiologists (Table 1). The following community US scans were amended to U1/U2 classifications: U3 49.4% (n= 39), U4 41.2% (n = 7) and U5 58.3% (n = 7). Of the patients referred on the pathway, 25.6% (n =67) underwent fine needle aspiration (FNA): 43.3% (n =29) yielded cytology ≥Thy3. The incidence of Thy5 nodules in the entire cohort was 5.0% (n =13): 1.1% (n =3) had Thy4 nodules.
| BTA Classification | Frequency (%) as per Community Ultrasound Results (n) | Frequency (%) as per Community Ultrasound Results (n) |
| U1 | 0.0 (0) | 11.2 (24) |
| U2 | 8.5 (11) | 54.0 (116) |
| U3 | 60.8 (79) | 25.6 (55) |
| U4 | 13.1 (17) | 5.1 (11) |
| U5 | 9.2 (12) | 4.2 (9) |
Conclusion and Discussion: Criteria for thyroid cancer two week wait referrals needs to be addressed given the low yield of results necessitating treatment. The role of community ultrasounds should be considered as part of the strategy.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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