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Original Research Thyroid Cancer Can We Improve Thyroid Fine-needle Aspiration Cytology Adequacy in a Low-volume Thyroid Center? Results of Surgeon-performed Ultrasound-guided Fine-needle Aspiration Cytology Mohamed Shaaban, Mario Metry, and Sebastian Aspinall Endocrine and Breast Surgery Unit, Northumbria Healthcare NHS Foundation Trust, Ashington, UK I ntroduction: Thyroid cancer is the most common endocrine malignancy, and has shown an increase in incidence in recent decades. Fine-needle aspiration cytology (FNAC) is the mainstay of assessment of thyroid nodules and diagnosis of malignancy. Several reports have suggested that ultrasound (US)-guided FNAC has many advantages over palpation-guided biopsy. Methods: Comparison of results of thyroid nodule FNACs in a low volume thyroid center (Northumbria Health Care NHS Foundation Trust) performed by a diverse group of clinicians and radiologists involved in the management of thyroid nodules over 18 months, between October 2008 and April 2010, identified retrospectively from pathology records, with the results of surgeon-performed US (SUS) -guided FNACs performed by a single operator (SRA) recorded prospectively over 17 months between July 2013 and November 2014. Results: The study included 185 FNA, with 104 FNAC being undertaken between October 2008 and April 2010 compared to 81 FNAC between July 2013 and November 2014. There was a statistically significant reduction of non-diagnostic rates in the second period: 23/81 (28%) versus 51/104 (49%) (Fisher’s exact, p=0.0063), non-neoplastic (Thy2) scores remained comparable: 28/81 (35%) versus 32/104 (31%), there were more Thy3 results: 21/81 (26%) versus 15/104 (14%), while the proportion of neoplastic results in the SUS-FNAC group increased: 8/81 (10%) versus 6/104 (6%). Also, time to diagnostic FNAC was significantly shorter in the SUS-FNAC group: 24.2 ± 4.5 versus 54.9 ± 11.4 days (p=0.01, unpaired t-test). Conclusion: SUS-guided FNAC for thyroid nodules is a safe and simple technique. This study demonstrates that it leads to improved patient care by reducing inadequacy rate and time to diagnosis in a low-volume thyroid center. Keywords Thyroid nodule, surgeon-performed ultrasonography, fine-needle aspiration cytology (FNAC), adequacy Disclosure: Mohamed Shaaban, Mario Metry, and Sebastian Aspinall have no conflicts of interest to declare. No funding was received in the publication of this article. Approval was obtained to carry out this audit, verbal consent was obtained for each fine-needle aspiration procedure. Compliance with Ethics: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: November 6, 2016 Accepted: January 3, 2017 Citation: Oncology & Hematology Review, 2017;13(1):21–4 Corresponding Author: Mohamed Shaaban, Endocrine and Breast Surgery Unit, Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington NE63 9JJ, UK E: dr.mohamed.shaaban@gmail.com Thyroid cancer is the most common endocrine malignancy, and has increased in incidence in recent decades. 1–3 Fine-needle aspiration cytology (FNAC) is the mainstay of assessment of thyroid nodules and diagnosis of malignancy. 4,5 Several reports have suggested that ultrasound (US)-guided FNAC has many advantages over palpation-guided biopsy. It is now generally recommended that thyroid nodules should be biopsied under US-guidance to improve diagnostic accuracy (British Thyroid Association Guidelines for the Management of Thyroid Cancer 2014). 6–8 Low adequacy rates of FNAC for thyroid nodules remains an issue, particularly in low-volume thyroid units with multiple clinicians performing this investigation. This leads to repeated FNACs and delays in diagnosis. Several strategies have been used to try to improve the diagnostic yield. 9 It was apparent that insufficiency rates of thyroid FNACs were high in Northumbria Trust, leading to increased patient hospital attendance, anxiety, delay in diagnosis and treatment. These audits were undertaken to assess whether surgeon-performed US (SUS)-guided FNAC could improve the adequacy rates of thyroid nodules FNAC and shorten the time to diagnosis in a low-volume thyroid center. Methods In the first period, the pathology department provided us with a list of all thyroids FNACs performed in the trust by a diverse group of clinicians TOU CH MED ICA L MEDIA 21