455 Fine-Needle Aspiration, Ultrasound and Thyroidectomies in Patients with Thyroid Nodules Presenting to a District General Hospital – a Retrospective Audit

Abstract

Abstract Aim To determine whether fine-needle aspiration, ultrasound and thyroidectomies were being performed appropriately in patients with thyroid nodules, and to compare the percentage of malignant cases for each histological classification with the national standards. Method Patients undergoing thyroidectomy in Northwest Anglia Trust (East of England) between October 2021 – October 2022 was identified retrospectively using the OPSC-4 codes. Medical records of 132 patients were retrieved, and data points extracted. Results We identified 103 female and 29 patients. The female cohort had a younger age distribution (median 52y) compared to the male cohort (59y). 42 patients underwent total thyroidectomy, 89 underwent hemithyroidectomy and 1 underwent lobectomy. 21% of the specimen was reported to be malignant, of which 74% was papillary cell carcinoma, 15% follicular cell carcinoma and 11% Hurthle cell carcinoma. Our percentage of malignancy in the Thy1a/c category was higher (5%) compared to the national figures of malignancy risk reported by RCPath (4%), whilst the rest were lower than the national figures (Thy2 = 0%, Thy3a = 13%, Thy3f = 19%, Thy4 = 50%, Thy5 = 94%). 100% of Thy3, Thy4 and Thy5 patients underwent diagnostic hemithyroidectomy. 15 patients did not have documentation of the U classification prior to thyroidectomy. There was 84% compliance with repeat FNAC requirements prior to surgery and 97% compliance with MDT discussion. Conclusions Current BAETS guideline states that thyroid nodules with benign appearances (U1 and U2) do not need to be followed-up, however we found a 15% of malignancy in these patients. Costs, risks and benefits of regularly undertaking fine needle aspiration in these patients must be considered.