Care and treatment
15. Mr U says between August and October 2023, and in particular at an appointment on 13 October, the Trust did not arrange a biopsy to investigate a lump on his thyroid gland because it said the lump was too small.
16. He also complains that, in making this decision, the Trust did not take into account he had previously worked as an operating department practitioner, a role that involved being present during the use of X-rays where he says he had not been provided with a throat collar. He is concerned that the Trust did not consider he was therefore at an increased risk of cancer and also believes it should have asked him whether he had previously been exposed to radiation.
17. The Trust said an ultrasound scan on 12 September showed Mr U’s nodule (growth) was below the recommended size for sampling and as a result removed him from the cancer pathway and booked him an appointment to see a head and neck consultant on 13 October. It said this consultant confirmed the nodule was smaller than the size recommended for sampling and advised Mr U it would continue to monitor his nodule with a further scan in a year’s time.
18. British Thyroid Association, Guidelines for the management of thyroid cancer outlines how the high sensitivity of ultrasound scans can cause thyroid nodules (a growth) of less than 1cm to be identified.
19. For such nodules it explains that FNAC (fine needle aspiration cytology – a biopsy) should not be routinely performed. Clinicians should consider the full clinical picture of the patient including if there is evidence of additional thyroid disease or an associated high risk clinical history in judging whether to arrange FNAC. The guidance specifically states clinicians need to avoid overtreatment of insignificant thyroid nodules.
20. United Kingdom National Multidisciplinary Guidelines, Management of thyroid cancer states:
‘FNAC should be considered for all nodules with suspicious ultrasound features. If a nodule is smaller than 10mm in diameter, USS (ultrasound) guided FNAC is not recommended unless clinically suspicious lymph nodules on USS are also present’
21. The records show on 30 June Mr U had an ultrasound of his neck which showed no enlarged lymph glands but did show an incidental thyroid nodule (a nodule not previously identified but identified by ultrasound). Staff classified this as suspicious for cancer and referred him to the thyroid team.
22. The thyroid team saw Mr U on 30 August and requested a repeat ultrasound scan which was performed on 12 September. This scan reported the same nodule measured 8 to 9mm and there were no suspicious lymph nodes (clusters of cells) present.
23. Staff reviewed Mr U in clinic on 13 October where they explained to him that he did not need a biopsy but would arrange a repeat ultrasound scan in one year’s time.
24. We understand from our adviser that staff acted in line with the relevant guidance. They explained that a biopsy was not necessary at the time based on the size of nodule and Mr U’s clinical presentation, but the Trust planned a further ultrasound at an appropriate later date to monitor it.
25. Our adviser further explained that the relevant guidance was put together to avoid unnecessary treatment of clinically insignificant cancers which would otherwise never have caused any symptoms.
26. We also asked our adviser about whether the Trust should have considered or asked about Mr U’s individual risk of developing cancer as a result of his life experiences. They explained staff should not as this was not relevant in relation to the guidance.
27. We are satisfied the Trust followed relevant guidance in the care and treatment it provided to Mr U on account of the lymph nodule it identified. This is because the nodule was less than 1cm in size at the time and Mr U did not present with any other clinical symptoms which would have caused staff to arrange a biopsy. There is no indication the Trust did anything wrong and we will take no further action.
28. We understand from Mr U that he later had a biopsy at another Trust and staff there decided to remove the nodule. He told us that within four weeks of that procedure staff at the other Trust told him he did not have cancer. Our decision here is not made without recognising Mr U’s experience after the events he complains about or the distress and anxiety he says he suffered. We are very pleased to hear he does not have cancer. We also hope he is reassured by our primary investigation that the Trust he complains about did nothing wrong in the care and treatment it provided.