83rd Annual Meeting of the American Thyroid Association:
Radiologist- vs Clinician-performed Ultrasound in Differentiated Thyroid Cancer
Ultrasound (US) is commonly utilized to diagnose and evaluate differentiated thyroid cancer (DTC). US can detect non-palpable pathology and metastasis to lymph nodes. Furthermore, its use is important in surgical planning and post-operative disease management.
Some patients are referred to a radiologist who performs US (R-US), interprets the results, and prepares the report. However, Kevin Parrack, MD and his colleagues from the Cleveland Clinic Foundation at Cleveland, OH wanted to know if "reliance on radiology reports alone can lead to an inadequate operation."1
The study involved a retrospective review of patients who underwent modified radical neck dissections (MRND) between 2000 and 2013 through the Cleveland Clinic Foundation's referral center. All the patients received clinician-performed US (C-US) prior to surgery. The data was compared to "pre-referral imaging studies" to determine how many patients could have undergone an incorrect surgical procedure because lateral neck pathology was not found.
Of the 137 patients who underwent MRND for DTC, 94 (69%) received pre-referral imaging of the neck, such as ultrasound, computed tomography, and magnetic resonance imaging. Forty-three (43) patients received pre-referral C-US.
- 29 patients (31%) received C-US, which detected non-palpable pathologic lateral lymph nodes confirmed by cytology.
- 55 patients (59%) received R-US, and in 19 (35%) C-US detected non-palpable cancerous lymph nodes.
In one-third of the cases, C-US (eg, surgeon performed) detected non-palpable pathologic lymph nodes missed by previous studies.
"Ultrasound prior to thyroidectomy is an important tool for planning surgery, in that it can delineate local extent of tumor and likely nodal metastases better than physical exam and alternative imaging modalities."2
—Julie Ann Sosa, MD
Doctor Sosa is the Program Committee Co-Chair; Professor of Surgery and Medicine, Chief, Section of Endocrine Surgery; Director Health Services Research, Department of Surgery at Duke University School of Medicine in Durham, NC.