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

Patel, Rajeshbhai; Skandarajah, Anita; Gorelik, Alexandra; Shears, Matthew J; Tasevski, Robert; Miller, Julie Ann

doi:10.1111/ans.13833

Cited by 9 publications

(12 citation statements)

References 19 publications

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“…Additionally, the anticipated surgeon remains fully engaged in the care of the patient from the initial examination through the postoperative period without the likelihood of sacrifi cing quality of care or treatment results. Consistent with this latter suggestion are the results reported by Patel and his associates [12]. They discovered that when the surgeon him or herself performed the thyroid FNAC with US there was a notable decrease in the time to diagnosis and treatment in over 100 cases, which in the fi nal analysis translated into signifi cantly fewer offi ce visits and more effi cient patient care.…”

Section: Discussionsupporting

confidence: 62%

Accuracy of non-ultrasound guided thyroid gland fine needle aspiration with biopsy

Grover¹,

Dworkin-Valenti²,

Jadusingh³

et al. 2018

Arch Otolaryngol Rhinold

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Section: Discussionsupporting

confidence: 62%

Accuracy of non-ultrasound guided thyroid gland fine needle aspiration with biopsy

Grover¹,

Dworkin-Valenti²,

Jadusingh³

et al. 2018

Arch Otolaryngol Rhinold

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“…On the other hand, for patients who needed a diagnostic ultrasound once in the clinical pathway, the median time for diagnosis was 166 days. A few other studies compared the timeliness of care of surgeon-performed UG-FNAC vs. radiologist-performed UG-FNAC in patients with thyroid nodules [ 24 , 25 , 26 ]. These studies only evaluated the period from puncture to diagnosis and reported a shorter delay in the first group as well as a reduction in costs [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Clinical Pathway for Thyroid Nodular Disease: Timings and Delays in the Diagnosis and Treatment of Thyroid Cancer

Sifontes-Dubón

García-López

González-Ortega

et al. 2021

JCM

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Background: Due to the high prevalence of nodular thyroid disease in the general population and the need to rule out malignant tumours, a clinical pathway for nodular thyroid disease was created at our tertiary-level hospital. Our study aimed to quantify timings and delays in diagnosis and treatment in this clinical pathway, specifically for patients who were diagnosed with thyroid cancer. Methods: A retrospective review was conducted of patients who were newly diagnosed with thyroid cancer and who had been previously evaluated in the clinical pathway for nodular thyroid disease at our institution during 2015–2017. Patient demographics, previous diagnostic studies, cytological results, tumour details and key dates were analysed to identify wait times in diagnosis and treatment. Results: Forty patients with thyroid cancer were included. The diagnostic delay had a median time of 60 days, and the treatment delay was dependent on cytopathological results. The main cause for delay in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. In the treatment phase, patients with a cytological result of Bethesda III, V or VI underwent surgery at the suggested time, while those in the Bethesda II or IV category did not. Conclusions: The major delay found in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. We are not suggesting that this step must be eliminated, though the implementation of routine ultrasonography in a thyroid clinic can help identify patients who need more urgent evaluation for fine needle aspiration cytology. In our hospital, decision for surgery is based mainly on the cytopathological report. Imaging studies and/or molecular testing could be considered to reduce treatment delays.

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“…In our institution, adjuvant therapy decisions post thyroidectomy are made in the context of a MDT meeting, which was first implemented in 2009 . Along with the published guidelines, and the expertise offered by this multi‐disciplinary group, carefully‐considered decisions are made regarding thyroid cancer treatment; both surgical (completion thyroidectomy, lymph node dissection) and non‐surgical (TSH suppression, RAI use).…”

Section: Discussionmentioning

confidence: 99%

“…In our institution, adjuvant therapy decisions post thyroidectomy are made in the context of a MDT meeting, which was first implemented in 2009. 18,19 Along with the published guidelines, and the expertise offered by this multi-disciplinary group, carefullyconsidered decisions are made regarding thyroid cancer treatment; both surgical (completion thyroidectomy, lymph node dissection) and non-surgical (TSH suppression, RAI use). This approach has also led to our adherence to guidelines, as has been reported by Moore et al in New York, where a similar change in RAI usage was reported following publication of the 2009 guidelines, with management decisions made within a multi-disciplinary environment.…”

Section: Discussionmentioning

confidence: 99%

Radioactive iodine ablation post differentiated thyroid cancer surgery: an analysis of use and impact of the American Thyroid Association guidelines

Sia

Dave

Nour

et al. 2019

ANZ Journal of Surgery

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Background The 2009 American Thyroid Association (ATA) three‐tiered risk stratification, and its updated version in 2015, provided clearer guidance on the use of radioactive iodine (RAI) ablation in differentiated thyroid cancer (DTC) patients. This study examines the impact of these guidelines on RAI use in our institution. Methods Patients diagnosed with DTC during three different time periods (group 1: 2002–2006, group 2: 2010–2014 and group 3: 2017–2018) were identified and risk stratified according to the ATA guidelines. RAI use and extent of surgery were compared between the three groups. Categorical variables were analysed using Fisher's exact (2 × 2) and chi‐squared (>2 × 2) tests. Results A total of 415 patients were included (group 1 = 88, group 2 = 215, group 3 = 112). The proportion of patients having total thyroidectomy were 84.6, 84.7 and 69.6% in groups 1, 2 and 3, respectively (P = 0.003). Central lymph node dissection was significantly higher in the more contemporary groups compared to group 1 (9.1 versus 41.9 versus 64.3%, P < 0.001). Overall, fewer patients received RAI in more recent times (76.6 versus 54.8 versus 26.8%, P < 0.001), most evident in the low‐risk patients (70 versus 29.1 versus 5.1%, P < 0.001). In the high risk group, the majority received RAI, with no difference between the groups. Conclusion Comparing DTC patients treated in our unit before and after publications of the 2009 and 2015 ATA guidelines, more nodal surgery was performed with less RAI administered in the latter groups. Better risk stratification according to the ATA guidelines has allowed more judicious use of RAI ablation.

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

Cited by 9 publications

References 19 publications

Accuracy of non-ultrasound guided thyroid gland fine needle aspiration with biopsy

Accuracy of non-ultrasound guided thyroid gland fine needle aspiration with biopsy

Evaluation of a Clinical Pathway for Thyroid Nodular Disease: Timings and Delays in the Diagnosis and Treatment of Thyroid Cancer

Radioactive iodine ablation post differentiated thyroid cancer surgery: an analysis of use and impact of the American Thyroid Association guidelines

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