Ultrasound assessment is one of the mainstays of thyroid nodule investigation. Ultrasound (US) is used to stratify which nodules undergo fine needle aspiration (FNA) and subsequent excision. No single US feature is diagnostic. 1 As such, classification systems are used to interpret the set of features found within a nodule. There are multiple classification systems for US assessment of thyroid nodules used around the world. [2][3][4][5][6] In the UK, the British Thyroid Association (BTA) recommends the use of the U classification. 3 The American College of Radiologists (ACR) propose using the Thyroid Imaging Reporting and Data System (TIRADS). 2 Both systems use five risk stratifications, but there are considerable differences in how they differentiate nodules. U classes are defined by the presence of characteristic US findings. TIRADS assigns classes by using the sum of a points system where each finding is assigned a score. The U classification includes intranodular vascularity as a U3 finding, despite conflicting literature on the significance of its presence. 1,7,8 In contrast, intranodular vascularity is not included in TIRADS. Abnormal lymphadenopathy is a U5 finding in

Objectives The aim of this study is to investigate factors that are associated with having a non‐localising 99mTc‐sestamibi scan. Design A retrospective study was performed on patients that underwent parathyroid surgery performed within a single institution between 2001 and 2018. Setting Single tertiary centre for parathyroid surgery. Participants 230 patients underwent surgery for primary hyperparathyroidism due to a solitary parathyroid adenoma and had preoperative 99mTc‐sestamibi imaging. Main outcome measures Variables including age, gender, intra‐operative location of parathyroid adenoma, adenoma weight and pre‐ and postoperative calcium and parathyroid hormone levels were investigated through univariate and multivariate analysis to identify any association with having a non‐localising (negative) 99mTc‐sestamibi scan result. Results Multivariate analysis identified that right‐sided adenomas (P = .038), superior adenomas (P = .042) and a lower preoperative PTH level (P = .034) were all individual factors associated with having a negative 99mTc‐sestamibi scan result. Although the weight of the adenoma was significant on univariate analysis (P = .029), this was not demonstrated on multivariate analysis (P = .422). Conclusion Factors that were associated with having non‐localising 99mTc‐sestamibi scan were right‐sided adenomas, superior adenomas and lower preoperative PTH level. Further large prospective multicentre studies are needed to further evaluate these initial findings.

Objective British Thyroid Association 2014 guidelines emphasised ultrasound assessment of nodules. One ultrasonographic differentiator of debatable relevance is intra-nodular vascularity. This is the first UK study conducted to address this question. Methods Ultrasound reports for thyroid surgery patients over 10 years were retrospectively reviewed. Reports documenting ‘intra-nodular vascularity or flow’ were analysed. Reports identifying peripheral vascularity only or no intra-nodular flow formed the control group. Concordance with final histology was used to determine the odds ratio for malignancy. Results A total of 306 patients were included, and 119 (38.9 per cent) nodules demonstrated intra-nodular vascularity. Of these, 60 (50.4 per cent) were malignant compared with 42 per cent in the control group. Intra-nodular vascularity was not a statistically significant predictor of malignancy with an odds ratio of 1.39 (p = 0.18, 95 per cent confidence interval, 0.86–2.23). Conclusion Intra-nodular vascularity in isolation was not a reliable predictor of malignancy. This supports other world literature studies. Although intra-nodular flow should not be relied upon in isolation, interpretation in conjunction with other suspicious findings enhances the predictive value.

Guidelines exist for operation notes from the Royal College of Surgeons of England but compliance has been shown to be variable. Aim The authors performed an audit of compliance with RCS standards in a colorectal department. Methods Thirty random operation notes were selected from a conserved pool. Their compliance was recorded against RCS good surgical practise record keeping and also looked particularly at fistula surgery and there documentation. Result Compliance was found to be poor and recommendations were put in place and the following was re audited. Conclusion As some specialities are developing operation note standards specific to individual procedures, the findings are compared with previous similar published work.