Impact of a multidisciplinary approach to ultrasound-guided thyroid fine-needle aspiration biopsy at Tygerberg Hospital, Cape Town, South Africa: A retrospective audit

• Published in: South African medical journal Vol. 112; no. 1; pp. 49 - 52
• Main Authors: Conradie, W, du Plessis, A, Edge, J, Baatjes, K, Ruiters, A, Razack, R
• Format: Journal Article
• Language: English
• Published: Health and Medical Publishing Group (HMPG) 2022; Health & Medical Publishing Group
• Subjects: Biopsy; Biopsy, Needle; Diagnosis; Diagnosis, Ultrasonic; Health care teams; Influence; Medical care; Methods; Quality management; Thyroid diseases; Thyroid gland; South Africa
• ISSN: 0256-9574; 2078-5135
• DOI: 10.7196/SAMJ.2022.v112i1.15906

Background Thyroid nodules are common and mostly benign. Inadequate sampling generally occurs in 13 - 17% of thyroid fine-needle aspiration biopsies (FNABs), but the proportion was found to be as high as 45% on evaluating 100 ultrasound (US)-guided FNABs in a previous unpublished audit at Tygerberg Hospital, Cape Town, South Africa (SA).Objectives Primary aim: To determine the diagnostic yield of US-guided thyroid biopsy after implementing changes to existing practices, involving the creation of a specialised clinic and applying protocols for referral and FNAB. Secondary aim: To compare the results with other centres in SA.Methods A retrospective audit of 178 thyroid biopsies was conducted. All US-guided thyroid biopsies performed in the specialised clinic between January 2017 and July 2018 were included. Data were analysed using descriptive statistics.Results The 178 nodules were biopsied in 159 patients. The mean age was 53.7 years, with a gender ratio of 9.6:1 (female/male). A reduction in non-diagnostic biopsies was noted compared with the historical cohort (45% v. 32.6%). Sixty-one nodules (34.3%) had previously been biopsied with inadequate cytology results. When repeat biopsies were excluded, only 16.2% (n=19) were classified as insufficient.Conclusions These findings illustrate the importance of the multidisciplinary approach and standardisation of the US-guided biopsy procedure and the value of consistency and quality control in a health system. While nodular thyroid disease is common and FNAB is relatively simple, early referral to a central specialised unit to minimise the incidence of inadequate FNAB should be considered.