Surgeon‐performed ultrasound changes surgical management in patients with thyroid cancer

Abstract

Background: A comprehensive neck ultrasound (US) is essential in the operative planning of patients with thyroid disease. Recent literature has shown surgeon-performed US (SUS) can be more accurate than radiology-performed US for the purpose of surgical planning. Missed findings on radiology-performed ultrasound may lead to inadequate surgical management. Methods: A retrospective cohort study of patients undergoing total thyroidectomy with lateral neck dissection for thyroid cancer, with both radiology-performed US and SUS performed by a Head and Neck surgeon. Ultrasound findings and adherence to American Thyroid Association (ATA) guidelines were compared, and changes in management based on SUS findings were identified. Results: A total of 26 patients who underwent total thyroidectomy with lateral neck dissection met the inclusion criteria. Preconsultation US investigations fulfilled criteria as recommended by the American Thyroid Association (ATA) guidelines in 57.7%% of cases. The central and lateral neck compartments were assessed in 57.7% and 84.6% of preconsultation US investigations respectively. Central and lateral metastatic neck metastases were incorrectly reported or not reported in 78.6% and 42.3% of cases. The SUS findings prompted a change in surgical management in 65.4% of cases. Conclusion: SUS changed surgical management in two thirds (65.4%) of patients. Reliance on radiology-performed ultrasound alone may result in incorrect staging. Awareness of the additional benefits of SUS is important for surgeons treating patients with thyroid disease to prevent inadequate surgery being performed.

Diagnostic adequacy and accuracy of surgeon‐performed ultrasound guided fine needle aspiration in lateral neck masses

“…In a study of patients who underwent a total thyroidectomy with lateral neck dissection for thyroid cancer with prior ultrasound by radiologists, surgeonperformed ultrasound was found to change surgical management in 65.4% of cases. 3 SUS-FNA has been extensively appraised in the setting of thyroid pathology, however SUS-FNA has distinct value in the investigation of lateral neck masses given the risks associated with treatment delay in head and neck squamous cell carcinoma. Delayed time to treatment beyond 60 days has been associated with poorer survival and greater risk of recurrence.…”

“…Head and neck surgeons have a unique understanding of neck anatomy and pathways of metastatic spread, which can aid in characterizing lesions and identifying biopsy targets. In a study of patients who underwent a total thyroidectomy with lateral neck dissection for thyroid cancer with prior ultrasound by radiologists, surgeon‐performed ultrasound was found to change surgical management in 65.4% of cases 3 …”

“…1,2 The surgeon is also afforded the ability to view real-time imaging of lesions and characterize aspects of the lesion and anatomy that can contribute to surgical decision making. 3 The majority of available literature appraising surgeon-performed ultrasound has focused on its utility in thyroid pathology, however there are significant benefits of surgeon-performed ultrasound FNA (SUS-FNA) in lateral neck masses. The most common malignant cause for a lateral neck mass is squamous cell carcinoma (SCC), which has been shown to progress and upstage when there is prolonged time to treatment initiation.…”

“…Although traditionally performed by radiologists, surgeon‐performed US‐FNA has been shown to reduce hospital visits and time to diagnosis and treatment 1,2 . The surgeon is also afforded the ability to view real‐time imaging of lesions and characterize aspects of the lesion and anatomy that can contribute to surgical decision making 3 …”