Ultrasound prior to thyroidectomy important for planning surgery

Ultrasound (US) imaging is commonly used to diagnose and evaluate patients with differentiated thyroid cancer (DTC), and to determine whether the disease has spread to lymph nodes in the neck that should be removed at the time of thyroidectomy. A retrospective review of cases spanning more than 12 years found that nearly a third of patients with DTC and neck metastases would not have had adequate operations if the surgeons had relied on pre-referral imaging studies and had not performed US themselves. A team of researchers from the Cleveland Clinic Foundation, Ohio, will present these findings in a poster at the 83rd Annual Meeting of the American Thyroid Association, October 16-20, 2013, in San Juan, Puerto Rico.

The poster, "The Importance of Clinician-Performed Ultrasound for the Proper Initial Surgical Management of Endocrine Surgery," presented by Kevin Parrack, presents several key results. Preoperative ultrasound performed by a surgeon detected affected lymph nodes that could not be felt on physical examination and were not identified on previous imaging studies performed by a radiologist in 31% of cases. Previous imaging tests done by radiology could have included US, computed tomography (CT), or magnetic resonance imaging (MRI). Among the patients who had radiologist-performed US specifically before being referred to an endocrine surgeon, 35% had non-palpable cancerous lymph nodes detected on clinician-performed US. The discovery that the cancer had spread beyond the thyroid gland altered the surgical plan and allowed for removal of the affected lymph nodes at the time of the thyroidectomy.

"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," says Julie Ann Sosa, MD, Program Committee Co-Chair; Professor of Surgery and Medicine, Chief, Section of Endocrine Surgery, and Director of Health Services Research, Department of Surgery, Duke University School of Medicine; and Leader, Endocrine Neoplasia Diseases Group, Duke Cancer Institute and Duke Clinical Research Institute, Durham, NC.."Different providers can perform the ultrasound and neck mapping, including surgeons, radiologists, endocrinologists, and pathologists. These data are significant in that they suggest the surgeon is uniquely positioned to perform ultrasound in a way that it affords critical information that would not otherwise be available for optimizing surgical approach."