J Clin Pathol doi:10.1136/jclinpath-2012-201339
  • Original article

A simplified economic approach to thyroid FNA cytology and surgical intervention in thyroid nodules

  1. Prashanth Kandaswamy2
  1. 1Department of Pathology, Queen Alexandra Hospital, Portsmouth, UK
  2. 2Centre for Clinical Practice, National Institute for Health and Clinical Excellence, Manchester, UK
  1. Correspondence to Dr David Nigel Poller, Department of Pathology, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK; david.poller{at}
  • Received 9 November 2012
  • Revised 24 February 2013
  • Accepted 25 February 2013
  • Published Online First 26 March 2013


Objective Few studies have modelled the economics of thyroid FNA.

Methods A simple spreadsheet economic model for delivery of thyroid fine needle aspiration (FNA) cytology is described using the UK Royal College of Pathologists’ Classification for thyroid FNA which is based on The Bethesda System for Reporting Thyroid Cytopathology.

Results We show an estimated 27.8% cost treatment reduction per patient if low rates of non-diagnostic for cytological diagnosis (Thy 1) and neoplasm possible atypia/non-diagnostic (Thy 3a) are achieved, which require rapid onsite FNA adequacy assessment of aspiration samples. If we assume that the number of thyroid FNAs performed in the UK annually is around 500 per million, and the UK population is 62 million, this could save the UK National Health Service significant sums, as the additional cost per patient treated in this model varies from £781 for a scenario with ultrasound guided FNA and inclinic cell adequacy assessment to £998 where aspirates are taken in conventional fashion without any inclinic adequacy assessment.

Conclusions This model makes a strong economic case for the introduction of rapid onsite assessment of thyroid FNA across cancer networks, to improve the diagnostic efficacy of thyroid FNA.

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