[Healthcare impact of introduction of thyroid ultrasound in a thyroid nodule pathology unit].
BACKGROUND
Worldwide incidence of thyroid cancer has increased in recent decades.


OBJECTIVE
To provide evidence of the diagnostic and care efficiency of a monographic thyroid nodule clinic integrating clinical examination, ultrasound examination, and cytology with on site evaluation.


METHODS
Patients attending the monographic thyroid nodule clinic from January 2004 to June 2010. Two periods may be distinguished based on availability of ultrasound equipment at the time of the visit: a first period (P1: 01/2004-09/2007) where no ultrasound equipment was available at the clinic and FNA by palpation was performed, and a second period (P2: 10/2007-06/2010) where this equipment was available and ultrasound-guided FNA was performed.


RESULTS
A total of 1036 patients [P1: 537 (52%), P2: 499 (48%)] were seen and enrolled. Diagnostic efficiency (P1 vs P2): 143 vs 181 patients were seen annually, p<0.001; FNA number/nodule: 1.68 vs 1.17, p<0.001; percent FNAs with inadequate material: 26% vs 5.3%, p<0.001; mean (SD) nodule size: 23.6 (12.4) vs 21.7 (11.7) mm, p 0.040; proportion of nodules examined less than 10mm in size: 9.9% vs 13.7%, p 0.030. Care efficiency: mean time (range) from the first visit to surgery indication: 332 (0-2177) vs 108 (0-596) days, p<0.001; proportion of patients referred for surgery due to suspect cytology/other reasons: 1.06 vs 2.21, p<0.001; and operated benign neoplasm/pathology: 0.47 vs 0.93, p=0.002.


CONCLUSIONS
A monographic thyroid nodule clinic integrating clinical examination, ultrasound, and cytology evaluated on site increases diagnostic and care efficiency in patients with thyroid nodules.
Unidad de Endocrinología, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, España. icastells@fhag.es
Ignasi
I
Castells
Núria
N
Pardo
Sebastián
S
Videla
Gabriel
G
Giménez
Esteve
E
Llargues
Olga
O
Simó
María Asunción
MA
Recasens
Xavier
X
Guirao
Xavier
X
Mira
Angel
A
Serrano
Anna
A
Sanmartí
D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology*; D016896:Treatment Outcome; D014463:Ultrasonography