Preoperative Ultrasound Used to Avoid Missing Metastases in Differentiated Thyroid Cancer

Ultrasound imaging is typically used to identify and assess patients with differentiated thyroid cancer (DTC), and to determine whether the disease has metastasized to lymph nodes in the neck that should be taken out at the time of thyroidectomy. A retrospective review of cases covering more than 12 years found that nearly one-third of patients with DTC and neck metastases would not have had adequate surgical procedures if the surgeons had relied on pre-referral imaging studies and had not performed ultrasound themselves.

A team of researchers from the Cleveland Clinic Foundation (OH, USA) presented these new findings at the 83rd annual meeting of the American Thyroid Association, October 16-20, 2013, held in San Juan (Puerto Rico). The study was presented by Dr. Kevin Parrack, and offered several major findings. Preoperative ultrasound performed by a surgeon detected affected lymph nodes that could not be felt on physical exam and were not identified on earlier imaging scans performed by a radiologist in 31% of instances. Earlier imaging tests performed by radiology could have included ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI).

Among the patients who had radiologist-performed ultrasound specifically before being referred to an endocrine surgeon, 35% had nonpalpable cancerous lymph nodes detected on clinician-performed ultrasound. 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,” said 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 (Durham, NC, USA). “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.”

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