Dr.Kumar Thulasidass SpR Endocrinology, North Middlesex Hospital, London

Dr.Penny Hyatt Consultant in Endocrinology, North Middlesex Hospital, London


  Methods –    We selected 25 patients over 6 months period between July 2008 to December 2008 who have had FNA of thyroid nodule and analysed if the procedure was done in accordance with the Royal College of Physicians guidelines and if the results of the FNA have been interpreted and acted upon  as per the guidelines.

Results of analysis –

  1. None of the cytology reports were done by histopathologist interested in Thyroid disease.
  2. 24/25 FNAs were done by physician interested in thyroid disease. 1 by radiologist.
  3. 6/25 cytopathology requests had clinical details. 3/25 requests had details of aspiration. 3/25 requests had details about site of aspiration.
  4. None of the procedures were communicated to pathologist regarding resolution of the mass.
  5. All reports by cytopathology lab included description and numerical coding.
  6. No additional investigations such as immunocytochemistry were requested.
  7. There were no suspicious lymph nodes in any of the 25 patients, as per ultrasound report and clinical examination details.

8.   11/25 procedures were diagnostic in the first attempt. 14/25 were non diagnostic –

      Repeat FNA was done only in 5 of the 14.

  1. 24/25 were non neoplastic. 1 showed evidence of Hurthle cell cancer. So referred

      to ENT surgeons.

  1. 3/25 had follicular lesion in FNAC. Among them 2 had lobectomy which was found

      to be non malignant. 1 patient was not referred for surgery

Conclusions -   

1.There were inadequate clinical details and details of the procedure and site of aspiration were not communicated to the histopathologist. 

However, it is difficult to get histopathologist interested in thyroid disease to do the analysis in all centers.

2.(i) repeat FNA was done in only 56% of those in whom  first FNA was non diagnostic.

  (ii)Among the three patients with follicular lesion, only two (66%) had immediate surgery.

  This delay could be dangerous.

  (iii)Ultrasound guidance was used for only 5 out of 14 (35%) patients in whom the first

  FNA attempt failed.

 FNA procedure will be improved by following the RCP guidelines more closely.