Department of Bio Med Surgery, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 154 Waterman St, Providence, RI 02906, USA.
World J Surg. 2010 Jun;34(6):1164-70. doi: 10.1007/s00268-010-0402-y.
Ultrasonography has become an indispensable tool in the evaluation of thyroid nodular disease, and most patients will have had a thyroid ultrasound prior to initial surgical evaluation. This study examines the added benefit of office-based, surgeon-performed ultrasonography in patients referred for thyroid disease.
All patients referred to a single endocrine surgeon for evaluation of thyroid disease over a 2-year period were reviewed. Outside ultrasonographic findings were compared to the surgeon-performed ultrasound that was used to formulate treatment decisions.
Of 286 consecutive patients referred for surgical evaluation of thyroid disease, 261 had an outside ultrasound available for comparison. There were 239 women and 47 men. Mean age was 54.7 +/- 16.6. In 46 patients (17.6%), differences between the two ultrasounds were significant enough to alter treatment plans. For 18 patients no distinct nodule was identified and biopsy was avoided. Nine of these patients had ultrasound characteristics of Hashimoto's disease. In five patients the nodule was significantly smaller than reported and biopsy was not warranted. Twelve patients had nonpalpable, enlarged lymph nodes not previously identified; these were biopsied. Three were positive for metastatic thyroid cancer, which prompted the addition of neck dissection to the operative procedure. In 8 of 132 patients undergoing thyroidectomy, the surgical procedure was significantly altered by the ultrasound findings.
This study demonstrates a clear advantage for patients who undergo a surgeon-performed ultrasound. For many, unnecessary procedures were prevented. For others, substantial modifications to the extent of surgery were made when new ultrasonographic findings were identified during the preoperative investigation.
超声检查已成为评估甲状腺结节疾病不可或缺的工具，大多数患者在初次手术评估前都会进行甲状腺超声检查。本研究探讨了在甲状腺疾病患者中进行门诊外科医生操作的超声检查的附加益处。
回顾了在 2 年内由一名内分泌外科医生评估甲状腺疾病的所有患者。将外部超声检查结果与用于制定治疗决策的外科医生进行的超声检查结果进行比较。
在 286 例连续转介接受甲状腺疾病手术评估的患者中，有 261 例有外部超声检查可供比较。其中 239 例为女性，47 例为男性。平均年龄为 54.7 ± 16.6 岁。在 46 例患者（17.6%）中，两种超声检查结果之间的差异足以改变治疗计划。对于 18 例患者，没有明确的结节，因此避免了活检。其中 9 例患者的超声表现符合桥本甲状腺炎。在 5 例患者中，结节明显小于报告中的大小，因此不需要活检。12 例患者存在先前未识别的无法触及的肿大淋巴结，对这些淋巴结进行了活检。其中 3 例为转移性甲状腺癌阳性，促使在手术过程中增加了颈部淋巴结清扫术。在 132 例行甲状腺切除术的患者中，有 8 例患者的手术过程因超声检查结果而发生显著改变。
本研究表明，对于接受外科医生进行的超声检查的患者，存在明显的优势。对于许多患者来说，避免了不必要的操作。对于其他患者，当在术前检查中发现新的超声检查结果时，对手术范围进行了实质性的修改。
