Cohen Oded, Lahav Gil, Schindel Doron, Halperin Doron
Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem, Rehovot, Israel.
Harefuah. 2020 Feb;159(1):128-131.
Surgeon performed ultrasound (SUS) has become a valuable tool for the head and neck/endocrine surgeon. It allows for a complementary examination of the neck, following history and physical examination. With its reduced costs and being radiation free, US has become the modality of choice for imaging thyroid, parathyroid and lymph nodes of the neck. In thyroid cancer, the role of US has constantly grown, as reflected in the latest American Thyroid Association (ATA) guidelines: The shift from whole body iodine scans to US has allowed for surveillance in low risk patients who underwent thyroidectomy, follow-up of microcarcinomas, and has a key role in the assessment of a thyroid nodule following initial aspiration. However, US is still limited by operator dependent inherent flaws, which are reflected by a relatively moderate inter-observer agreement, even among experts. When conducted by the same surgeon, SUS allows the patients to enjoy the benefits of US while overcoming this limitation. When compared to radiologist-performed US, several studies have shown that high volume surgeons can reach non-inferior predicative values for malignant nodules, using accepted suspicious sonographic features such as solid texture, hypoechogenicity, microcalcifications, irregular margins and taller rather than wider shape. Several studies have tried to answer the most important utility of SUS - its ability to change the course of management of the cases. In all studies SUS was able to change the management of the cases in 17-45% of the patients, extending surgery in some patients while avoiding unnecessary dissections in others. In summary, SUS is an important, feasible tool for the head and neck and endocrine surgeons. Studies have shown that high volume surgeons can reach excellent rates of prediction and detection, thus saving the patients unnecessary clinic visits, tension and additional imaging, and can even directly influence the management of the patients.
外科医生实施的超声检查（SUS）已成为头颈/内分泌外科医生的一项重要工具。在病史采集和体格检查之后，它可用于对颈部进行补充检查。由于成本较低且无辐射，超声已成为颈部甲状腺、甲状旁腺及淋巴结成像的首选方式。在甲状腺癌中，超声的作用不断增强，这在最新的美国甲状腺协会（ATA）指南中有所体现：从全身碘扫描转向超声，使得对接受甲状腺切除术的低风险患者进行监测、对微小癌进行随访成为可能，并且在初次细针穿刺后对甲状腺结节的评估中发挥着关键作用。然而，超声仍受限于依赖操作者的固有缺陷，即使在专家之间，观察者间的一致性也相对一般。当由同一位外科医生进行操作时，SUS在克服这一局限性的同时，让患者能够受益于超声检查。与放射科医生实施的超声检查相比，多项研究表明，经验丰富的外科医生利用诸如实性质地、低回声、微钙化、边界不规则以及纵横比大于1等公认的可疑超声特征，对恶性结节能够达到非劣效的预测值。多项研究试图解答SUS的最重要用途——其改变病例管理流程的能力。在所有研究中，SUS能够改变17%至45%患者的病例管理，在一些患者中扩大手术范围，而在另一些患者中避免不必要的解剖。总之，SUS是头颈及内分泌外科医生的一项重要且可行的工具。研究表明，经验丰富的外科医生能够达到出色的预测和检测率，从而为患者节省不必要的门诊就诊、减轻焦虑并避免额外的影像学检查，甚至能够直接影响患者的治疗管理。
