Surgeon-performed ultrasonography ‘indispensable’ for thyroid disease detection

By Sarah Guy

Ultrasonography (US)-guided fine-needle aspiration biopsy (FNAB), when performed by a surgeon, offers benefits in terms of clinical accuracy in detecting thyroid disease, show Turkish study results.

Even without onsite specimen evaluation, almost all (95%) of the surgeon-performed US-guided FNABs in the study achieved successful diagnosis, with the majority of specimens identified, and confirmed by imaging, as benign.

The benefits of surgeons completing the procedure include a reduction in complications and sampling errors, elimination of various department appointments, and performing each step of the diagnosis in a single hospital visit, thereby reducing cost, say the researchers.

"Surgeon-performed US serves as an indispensable tool in the diagnosis and treatment of a variety of surgical diseases," write Guldeniz Karadeniz Cakmak and colleagues from Zonguldak Karaelmas University in the Journal of Surgical Oncology.

It enables a large percentage of patients with benign thyroid disease to avoid surgery by means of meticulous diagnostic evaluation; US-guided FNAB is extremely helpful for accurate sampling in difficult cases, while reducing the occurrence of false-negative results, remark the researchers.

The study cohort included 533 patients who received 621 surgeon-performed US-guided FNABs for evaluation of thyroid disease between 2008 and 2010, and were followed up for between 10 and 35 months.

The overall nondiagnostic rate was just 5.48%, report the researchers, and of those with results, most had benign specimens (86.54%) with just 4 patients (0.68%) positive for malignancy.

All participants underwent ultrasound examination before referral for FNAB, and just 5.47% of the cohort (n=30) had clinical differences significant enough to alter their invasive treatment algorithm.

Indeed, the sensitivity, specificity, positive predictive and negative predictive accuracy were all high, at 100.0%, 86.2%, 55.6%, and 100.0%, respectively, and the overall diagnostic accuracy rate after ultrasound comparison was 88.2%, reports the research team.

These high rates support the idea that "surgeon-performed US as a routine part of evaluation provides innumerable patient and surgeon benefits," remark Cakmak et al, who believe the realtime imaging allowed for reduction of sampling errors.

From the perspective of surgical decision-making, they conclude, the US-guided procedure "considerably improves surgeon's satisfaction in terms of predicting disease extent before operation."

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