Division of General Surgery, Department of Surgery, Faculty of Medicine and Health Sciences, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa.
S Afr Med J. 2022 Feb 2;112(1):13521.
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(FNABs), but the proportion was found to be as high as 45% on evaluating 100 ultrasound (US)-guided FNABs in a previous unpublished audit at Tygerberg Hospital, Cape Town, South Africa (SA).
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.
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.
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.
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.
甲状腺结节很常见，大多为良性。在南非开普敦泰格尔伯格医院（Tygerberg Hospital）之前进行的一项未发表的审计中，甲状腺细针抽吸活检（FNAB）中，13-17%的样本采集不足，但在评估 100 例超声（US）引导的 FNAB 时，发现这一比例高达 45%。
主要目的：确定在实施现有实践变更后，即创建专门诊所并应用转诊和 FNAB 协议后，US 引导的甲状腺活检的诊断率。次要目的：与南非的其他中心进行比较。
对 178 例甲状腺活检进行回顾性审计。纳入 2017 年 1 月至 2018 年 7 月在专门诊所进行的所有 US 引导的甲状腺活检。使用描述性统计分析数据。
在 159 例患者中对 178 个结节进行了活检。平均年龄为 53.7 岁，性别比为 9.6:1（女/男）。与历史队列相比，非诊断性活检的数量有所减少（45%比 32.6%）。61 个结节（34.3%）以前进行过细胞学结果不足的活检。当排除重复活检后，只有 16.2%（n=19）被归类为不足。
这些发现表明了多学科方法的重要性，以及 US 引导的活检程序的标准化，在卫生系统中一致性和质量控制的价值。虽然结节性甲状腺疾病很常见，FNAB 相对简单，但应考虑将其早期转介到中央专门单位，以尽量减少 FNAB 不足的发生率。
