Usefulness of ultrasonography in the management of nodular thyroid disease.

BACKGROUND

Fine-needle aspiration biopsy is the standard diagnostic test for evaluating possible malignancy in a thyroid nodule.

OBJECTIVE

To evaluate the role of routine ultrasonography in the management of nodular thyroid disease.

DESIGN

Retrospective chart review.

SETTING

Multidisciplinary thyroid nodule clinic (endocrinology and radiology).

PATIENTS

Patients with suspected nodular thyroid disease or suspected recurrent thyroid cancer referred between October 1995 and March 1997. All patients had thyroid ultrasonography and ultrasonography-guided fine-needle aspiration biopsy of nodules at least 1 cm in maximum diameter.

MEASUREMENTS

Medical records, ultrasonography findings, cytology reports, and histologic reports were reviewed. Ultrasonography findings were compared with the referring physician's findings on physical examination.

RESULTS

223 patients were seen in the clinic. A total of 209 fine-needle aspiration biopsies were performed on 156 patients. Among 50 of 114 patients referred for a solitary nodule, ultrasonography detected additional nonpalpable nodules at least 1 cm in diameter in 27 and determined that no nodules required aspiration in 23. Of 59 patients referred for a diffuse goiter or a multinodular gland, ultrasonography detected discrete nodules at least 1 cm in diameter that required aspiration in 39 and determined that aspiration was unnecessary in 20.

CONCLUSIONS

Ultrasonography altered the clinical management for 63% of the patients (109 of 173) referred to the thyroid nodule clinic after abnormal results on thyroid physical examination.