One-stop thyroid nodule clinic with same-day fine-needle aspiration cytology improves efficiency of care

Abstract

BACKGROUND: Thyroid nodules are a common presenting complaint for endocrine surgeons; many require ultrasound-guided fine-needle aspiration cytology (US-FNAC). In an attempt to streamline our service, we introduced same-day surgeon-performed US-FNAC in 2014. METHODS: Three groups were defined: (A) retrospective group with FNAC performed in radiology prior to August 2014; (B) prospective radiology FNAC group; and (C) prospective surgeon-performed group. Demographics, nodule characteristics, pathology and management plans were recorded. The number and dates of hospital attendances were extracted from the patient information system. RESULTS: Over 4 years, 635 patients underwent 757 FNACs. There were 438 patients in group A, 78 in group B and 119 in group C. Patient demographics and nodule size were similar between groups. Those patients undergoing FNAC in endocrine surgery clinic required two visits prior to receiving a diagnosis and management plan, compared with three visits for those performed in radiology. Non-diagnostic rates between three groups were 6.5%, 7.4% and 5.4% (P = 0.842) whilst malignant FNAC results occurred in 3%, 4% and 8% (P = 0.015) respectively. Median time from US-FNAC to definitive management plan was 42, 41 and 14 days (P < 0.001). The introduction of the one-stop clinic resulted in a 41% reduction of patients attending the radiology department for FNAC. CONCLUSION: Surgeon-performed US-FNAC decreases the time from fine-needle aspiration request to definitive plan and reduces the number of patient visits, providing more efficient care. Patients referred to the endocrine surgery clinic with thyroid nodules have thyroid cancer more frequently than patients referred to radiology.