Solitary thyroid nodule: audit shows improved care requires cytological diagnosis

An audit was conducted of all patients undergoing thyroid surgery in a district general hospital over the 8-year period during which fine needle aspiration cytology (FNAC) was introduced. Of the 252 patients, 32 (14%) were toxic and 92 (36%) had large multinodular goitres, but 118 (46%) had a solitary thyroid nodule removed to exclude neoplasm. However, only 12.7% of such resected nodules were found to be carcinomas. Where FNAC was used, the accuracy for preoperative diagnosis was 82.6% and the sensitivity for prediction of carcinoma was 87.5%. Cytology correctly predicted 81% of the colloid nodules and these may have been managed without surgery if the patient was agreeable. It is suggested that one-half of the patients with solitary thyroid nodules could have been spared operation. Analysis of the operative procedure shows that one-fifth of the neoplasms may have been more accurately dealt with had FNAC been used, and four patients could have avoided the trauma and risks of a second operation. The study suggests that FNAC and increased specialisation will improve the quality of thyroid surgery in a district general hospital.