Internationally Standardized Method Of Fine Needle Aspiration For Thyroid Nodule Improved The Preoperative Cytology Diagnostic Rate For Thyroid Nodule

Thyroid nodule is a common clinical issue.Our previous study showed that the prevalence of thyroid nodule was 46.6%among the population aged at 40 or above in Gulou Community of Nanjing city.The malignancy rate is 7-15%of all thyroid nodules.According to the recent guideline from American Thyroid Association,all patients with thyroid nodules need to undergo clinical evaluation,ultrasound examination after which FNA is offered as needed.After all these investigations decision will be made as to undergo surgery or follow up.In contrast,majority of patients in China often are offered surgery as first line choice without thorough investigations including FNA as the guideline suggested.The impact of this model on economic issue and medical resources has not been reported.The first part of current study has focused on this issue which is the financial impact of thyroidectomy as treatment for thyroid nodule without a routine performance of FNA preoperatively.We recruited patients receiving thyroidectomy as the only purpose for admission from 2008 to 2013 in the First Affiliated Hospital of Nanjing Medical University.Parameters from histologically proven benign and malignant nodules were compared.We found that the malignancy rate increased from 26.5%in 2008 to 41.6%in 2013.The rate of all cost for patients with malignancy nodules among the cost of all patients was increased from 30.2%to 45.2%.The length of stay all decreased for patients with benign or malignant nodules,on the other hand cost for each admission all increased thorough these years.To estimate by using the data for the National Bureau of Statistics,all the cost for thyroidectomies in China was about 1.86 billion USD in 2012 in which 1.09 billion USD were used for the non-cancer thyroid thyroidectomiesWe could learn from the data above that the malignancy rate has improved in recent years,however the cost of thyroidectomy for benign thyroid nodules still constitute more than half of the cost for all the thyroid nodules.Many of these thyroidectomies could have been avoided by using appropriated preoperative methods including thyroid FNA.The diagnostic rate of thyroid FNA was generally low in China.Our previous report showed that satisfactory rate of FNA was only 40%.As a result,improving the diagnostic rate is a necessity.By combining the experience of our own and what I have learned at Brigham and Women’s hospital,Harvard Medical School,we developed a novel method called internationally standardized method for thyroid FNA.To validate the effectiveness of this new method,we carried out a series of clinical studies.In the first part we recuited 718 thyroid nodules from 695 patients who were given two different ways of thyroid FNA as preset sequence.332 patients received traditional method using 22G needle,while the other 386 patients used new method.We found that the non-diagnostic rate in the new method group was 35%significantly lower than 58%in the group using traditional method.In conclusion,new method could remarkably improve the preoperative diagnostic rate for thyroid nodules.Although our new method increased the diagnostic rate,the general diagnostic rate was only 65%.After exclusion for cystic and mixed nodules,the diagnostic rate was still 73%.Compared to the diagnostic rate of 87-92%from the world famous medical institute Harvard Medical School,there was still a wide gap.To fill in this gap,we initiated another study using the combination of internationally standardized thyroid FNA and liquid based cytology using SurePath.We prospectively recruited 304 patients with thyroid nodules.We used two methods for each thyroid nodules.The diagnostic rates of each method alone and combined were compared.The diagnostic rate of combined methods was 91.3%which was fairly close to 92%from the data of Harvard Medical School.Thyroidectomy without a routine preoperative FNA resulted in a low malignancy rate.Majority of thyroidectomies for benign thyroid nodules consumed plenty of medical resources which might be unnecessary.Low performance rate due to low diagnostic rate may be one of the important reasons.Internationally standardized fine-needle aspiration combined with liquid based cytology using SurePath can remarkably improve the diagnostic rate.This novel method is worthy of further application.