Thyroid U-scoring and subsequent fine needle aspiration cytology: A quality improvement project


The British Thyroid Association (BTA) 2014 guidelines recommend assigning a U-score to thyroid nodules based on their sonographic characteristics and advise which nodules require ultrasound-guided fine needle aspiration cytology (FNAC) based on the U-score. They also recommend which sampled nodules require further management, including repeat FNAC, based on their cytology results (Thy-score). This has implications in terms of time, cost and on the two-week rule pathway. This quality improvement project assessed compliance with these guidelines.


Thyroid ultrasound reports were reviewed for a U-score and whether FNAC was subsequently performed in the appropriate patients based on the U-score in line with the current BTA 2014 guidelines. A change was proposed by educating sonographers and placing laminated educational U-scoring guidelines with corresponding ultrasound examples in all ultrasound rooms to increase compliance with the guidelines with a target of 100% of ultrasound reports to include a U-score and FNAC to be performed in U3-U5 nodules only.


Before the intervention, 61 out of 132 scans (45%) included a U-score and 9 out of 12 patients had FNAC when radiologically indicated. Three patients who did not have FNAC died or were needle phobic. After the intervention, 44 out of 78 scans (56%) included a U-score. 11 out of 11 patients either had or were referred for FNAC when radiologically indicated.

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