Shalaby Mahmoud, Hadedeya Deena, Lee Grace S, Toraih Eman, Kandil Emad
5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
Am Surg. 2020 Sep;86(9):1148-1152. doi: 10.1177/0003134820945229. Epub 2020 Aug 27.
The 2015 American Thyroid Association Management Guidelines for patients with thyroid nodules recommended a comprehensive sonographic evaluation of thyroid nodules' characteristics and the presence of any suspicious cervical lymph nodes (LNs) in the central and lateral compartments. This detailed sonographic assessment is still not routinely performed. We hypothesized that an endocrine surgeon-performed ultrasound (SUS) significantly enhances the management of thyroid cancer patients when compared with referral ultrasound (RUS).
We conducted a retrospective review of 267 consecutive thyroid surgery patients who were diagnosed with thyroid cancer on final pathology. All patients had undergone a SUS, but only 130 cohorts with both RUS and SUS were included. Features of thyroid nodules and LN and changes in the management plan were recorded.
Based on SUS assessment, 26 patients (20%) were noted to have suspicious thyroid nodules which warranted a fine-needle aspiration (FNA) and were missed in RUS. On FNA, there were 12 patients with Bethesda categories III/IV and 14 patients with Bethesda V/VI. Those 26 patients were found to have a malignancy in the final pathology assessment. Thirty-eight patients (29.2%) were noted to have suspicious central/lateral neck findings on SUS but were not reported in RUS. Additionally, 8 patients (6.1%) were found to have a parathyroid adenoma by SUS and required concurrent parathyroidectomy.
A comprehensive neck ultrasound in thyroid cancer patients, performed by their endocrine surgeon, could enhance management planning and outcomes. This finding highlights the critical need for education and improvement of routine neck ultrasonographic examination performed in the community.
2015年美国甲状腺协会发布的甲状腺结节患者管理指南建议对甲状腺结节的特征以及中央区和侧方区可疑颈部淋巴结的情况进行全面的超声评估。但这种详细的超声评估仍未常规开展。我们推测，与转诊超声（RUS）相比，由内分泌外科医生进行的超声检查（SUS）能显著改善甲状腺癌患者的管理。
我们对267例连续接受甲状腺手术且最终病理诊断为甲状腺癌的患者进行了回顾性研究。所有患者均接受了SUS检查，但仅纳入了130例同时有RUS和SUS检查结果的队列。记录甲状腺结节和淋巴结的特征以及管理计划的变化。
根据SUS评估，发现26例患者（20%）有可疑甲状腺结节，需要进行细针穿刺抽吸活检（FNA），而这些结节在RUS检查中被漏诊。FNA检查结果显示，12例患者为贝塞斯达分类III/IV类，14例患者为贝塞斯达V/VI类。在最终病理评估中，这26例患者均被发现患有恶性肿瘤。38例患者（29.2%）在SUS检查中发现颈部中央/侧方有可疑表现，但RUS检查未报告。此外，SUS检查发现8例患者（6.1%）患有甲状旁腺腺瘤，需要同时进行甲状旁腺切除术。
由内分泌外科医生对甲状腺癌患者进行全面的颈部超声检查，可以改善管理计划并提高治疗效果。这一发现凸显了对社区常规颈部超声检查进行教育和改进的迫切需求。
