title: Efficient evaluation of thyroid nodules by primary care providers and thyroid specialists.
abstract: OBJECTIVE
  To determine whether primary care providers and thyroid specialists at Gundersen Lutheran Medical Center are evaluating thyroid nodules efficiently by following recently published clinical guidelines.
  
  
  METHODS
  One-year retrospective chart review.
  
  
  METHODS
  We reviewed patient records from 1996 and tabulated the use of fine-needle aspiration cytology, radionuclide scanning, and thyroid ultrasonography by 49 primary care physicians evaluating 81 thyroid nodules and by 5 thyroid specialists evaluating 29 thyroid nodules. The results were compared with our previous findings and those recently reported by others.
  
  
  RESULTS
  Fine-needle aspiration cytology was widely used by both groups of Gundersen Lutheran healthcare providers. Primary care physicians used imaging studies modestly and generated $106 per patient in unnecessary costs. Thyroid specialists occasionally used radionuclide scanning but did not use thyroid ultrasonography; they generated $41 per patient in unnecessary costs. Overall, the introduction of fine-needle aspiration cytology at our institution has reduced the use of radionuclide scanning from 90% to 12% and the use of thyroid ultrasonography from 30% to 10%. We also found that the frequency of surgery in patients with thyroid nodules fell substantially, yet detection of thyroid cancer in the operative specimens increased from 16% to 43% while the cost of removing a thyroid carcinoma decreased from $64,000 to $25,000.
  
  
  CONCLUSIONS
  Fine-needle aspiration cytology, adopted as the initial test for diagnosing thyroid nodules by most of our healthcare providers, has reduced the use of imaging studies far below the frequency reported by others and has substantially decreased the cost of thyroid nodule management.
authors.affiliation: Department of Pathology, Gundersen Lutheran Medical Center, La Crosse, WI, USA. rcaplan@gundluth.org
authors.forename: R H
authors.initials: RH
authors.lastname: Caplan
authors.forename: S M
authors.initials: SM
authors.lastname: Wester
authors.forename: P J
authors.initials: PJ
authors.lastname: Lambert
authors.forename: B L
authors.initials: BL
authors.lastname: Rooney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D004704:Endocrinology / Q000592:standards*; D005194:Family Practice / Q000592:standards; D005260:Female; D013502:General Surgery / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D007388:Internal Medicine / Q000592:standards; D008297:Male; D008875:Middle Aged; D010823:Physician Assistants / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D011877:Radionuclide Imaging; D013961:Thyroid Gland / Q000473:pathology*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography; D014922:Wisconsin