Pathological practice and management of thyroid nodules: a Thai perspective

Area of Science:

• Endocrinology
• Oncology
• Pathology

Background:

• International guidelines exist for thyroid nodule diagnosis and management.
• Variations in physician practices persist globally due to differing local contexts.
• Thailand aims to align with international standards despite some limitations.

Purpose of the Study:

• To assess current practices and limitations in thyroid nodule management across Thailand.
• To evaluate the performance of fine needle aspiration (FNA) in the country.
• To identify key challenges in diagnosis and treatment of thyroid lesions.

Main Methods:

• A survey was conducted among surgeons, radiologists, and pathologists involved in thyroid lesion management.
• Data collection involved personal phone contact and custom online questionnaires.
• Fine needle aspiration (FNA) performance was evaluated using available publication data and compared to literature.

Main Results:

• Key administrative issues include a shortage of pathologists and unequal resource allocation.
• Physicians, especially clinicians, show limited awareness of new diagnostic terminologies like NIFTP, UMP, Bethesda, and TI-RADS.
• Thai FNA results indicate a high rate of non-diagnostic samples (30.5% Bethesda I) and significant false negativity (9.6% malignancy risk in Bethesda II).
• Molecular studies, though beneficial for diagnostic accuracy, are not routinely used due to limited availability.

Conclusions:

• Thyroid nodule management in Thailand is hindered by administrative and educational challenges.
• Suboptimal FNA performance necessitates improvements in diagnostic procedures and training.
• Enhanced continuous medical education and wider access to advanced diagnostic tools are crucial for improving patient care.