Endocrine Surgeon-Performed US Guided Thyroid FNAC is Accurate and Efficient Dhafir Al-azawi • G. Bruce Mann • Rodney T. Judson • Julie A. Miller Published online: 18 April 2012 Ó Socie ´te ´ Internationale de Chirurgie 2012 Abstract Background Ultrasound guided fine needle aspiration cytology (US-FNAC) is a key diagnostic technique used to assess thyroid nodules. This procedure has been the domain of radiologists, but it is increasingly performed by endo- crine surgeons. In the present study we aimed to assess the accuracy and clinical efficiency of US-FNAC performed by endocrine surgeons. Patients and Methods This study was a retrospective review of consecutive patients in a 3-year period who underwent US-FNAC performed by endocrine surgeons and radiologists. Medical records, cytology results, and surgical pathology results were collected and analyzed. Results A total of 576 US-FNAC were performed on 402 patients during the study period. The endocrine surgeons and radiologists performed 299 and 277 US-FNAC, respectively. The FNAC inadequacy rate was 5.3 % for the endocrine surgeons and 9.3 % for the radiologists (p = 0.05). For thyroid cancer, the sensitivity, specificity, and false negatives of the US-FNAC for the endocrine surgeons was 87 %, 98 %, and 3 %, respectively while that for the radiologists was 88 %, 95 %, and 3.5 %, respec- tively. Patients with thyroid cancer had a shorter time to surgery in the endocrine surgeons’ group (mean 15.3 days) compared to the radiologists’ group (mean: 53.3 days; p = 0.01). Conclusions US-FNAC performed by an experienced endocrine surgeon is accurate and allows efficient surgical management for patients with thyroid cancer. Introduction Thyroid nodules are common and have become a signifi- cant clinical problem with the widespread use of diagnostic ultrasound. Accurately and efficiently distinguishing between clinically insignificant nodules and those requiring intervention is important [1]. Some 95 % of thyroid can- cers present as solitary nodules, yet fewer than 15 % of thyroid nodules are malignant [2]. Ultrasound guided FNAC is a technique employed to help address the likeli- hood of thyroid cancer in patients with nodular thyroid disease [3]. Fine needle aspiration cytology is a safe and effective method of differentiating benign from suspicious or malignant nodules [4], with the sensitivity and speci- ficity of thyroid FNAC being around 85 % and 90% in experienced hands [5]. Ultrasound guided FNAC is there- fore able to help determine which patients with thyroid nodules require surgery, and to determine the extent of surgery. Traditionally, thyroid US-FNAC has been the domain of the radiologist, as ultrasound and US-FNAC is a core competency acquired during radiology training. Endocrine surgeons have begun to undertake US and US- FNAC training, and to perform the procedure as part of a surgical consultation [6]. As patients with thyroid nodules are often referred for a surgical opinion, this development may streamline patient care. Potential advantages include convenience for patients and direct feedback for surgeons. Before US performed by endocrine surgeons becomes accepted as standard, it is important to assess its accuracy and efficiency. We therefore conducted a retrospective comparison of the adequacy of US-FNAC samples obtained by surgeons and those obtained in the department of radiology at an academic hospital. We also assessed the time between biopsy and surgery for patients with thyroid cancer. D. Al-azawi (&) Á G. B. Mann Á R. T. Judson Á J. A. Miller Department of Surgery, Endocrine Surgery Unit, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia e-mail: dalazawi@rcsi.ie 123 World J Surg (2012) 36:1947–1952 DOI 10.1007/s00268-012-1592-2