Surgeon-performed ultrasound-guided fine needle aspiration of thyroid nodules is cost effective and efficient: evaluation of thyroid nodule assessment in a provincial New Zealand hospital.

AIM: Surgeon-performed ultrasound-guided fine needle aspiration cytology (US-FNAC) and radiologist-performed US-FNAC are both accepted forms of thyroid nodule assessment. To date there have been no studies comparing cost of evaluation between these two models. The aim of this study is to compare surgeon-performed thyroid US-FNAC to radiologist-performed US-FNAC. The primary outcome of interest was cost of surgeon-performed US-FNAC compared to cost of radiologist-performed US-FNAC. Secondary outcome of interest was time to treatment decision. METHODS: A retrospective analysis of all thyroid biopsies performed in 2016 and 2017 in a single centre were included. Costs were calculated using labour costs for SMO and allied technical personnel. RESULTS: There were 92 patients included in the analysis. Forty-two underwent surgeon-performed US-FNAC and 50 underwent radiologist-performed US-FNAC. Mean cost in surgeon-performed US-FNAC was $653 compared to $1017 in radiologist-performed US-FNA. Time from first appointment to definitive management plan was 47 days in surgeon-performed USFNAC and 116 days in radiologist-performed US-FNAC. CONCLUSIONS: This study demonstrates surgeon-performed US-FNAC for evaluation of thyroid nodules results in significantly lower costs and improved timeliness of care when compared to radiologist-performed US-FNAC.

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

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.