Importance of surgeon-performed ultrasound in the preoperative nodal assessment of patients with potential thyroid malignancy

Monteiro, Rosebel; Han, Amy; Etiwy, Muhammad; Swearingen, Andrew J.; Krishnamurthy, Vikram D.; Jin, Judy; Shin, Joyce; Berber, Eren; Siperstein, Allan

doi:10.1016/j.surg.2017.10.005

Cited by 20 publications

(15 citation statements)

References 19 publications

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“…Ultrasound suffers the limitations of being non-specific [29][30][31]. CT has been introduced to an augment technique of diagnosis of thyroid disease [32]. However, if CT demonstrates low-attenuation mass in thyroid with additional features, for example, linear high-density strand sign, plus ultrasound evidence of marked hypoechogenicity, enhanced posterior echo, or cervical lymphadenopathy, the diagnosis is probably thyroid lymphoma [33].…”

Section: Discussionmentioning

confidence: 99%

Is ultrasound combined with computed tomography useful for distinguishing between primary thyroid lymphoma and Hashimoto’s thyroiditis?

Luo

Huang

Zhou

et al. 2019

Endokrynologia Polska

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Introduction: The aim of the study is to investigate the usefulness of ultrasound combined with computed tomography (CT) for distinguishing between primary thyroid lymphoma (PTL) and Hashimoto's thyroiditis (HT). Material and methods: The investigation was conducted retrospectively in 80 patients from January 2000 to July 2018. All patients underwent pathological tests to be classified into one of two groups: PTL group and HT group. The cutoff value of CT density was determined using receiver-operating characteristic (ROC) curve analysis. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of diagnosis for thyroid by CT alone, ultrasound alone, and the combination of CT plus ultrasound were calculated. Results: Of the 80 study patients, 27 patients were PTL and 53 patients were HT. Mean CT density had a sensitivity of 90.6% and a specificity of 88.9% at a cutoff value of 53.5 HU, with area under the curve (AUC) 0.88. Ultrasound combined with CT had the highest specificity, accuracy, and PPV compared with CT alone and ultrasound alone (p value < 0.05). Conclusions: Features such as extremely hypoechogenicity, enhanced posterior echo, cervical lymphadenopathy in ultrasound image, and linear high-density strand signs, and very low density in CT imaging have high sensitivity and specificity in thyroid lymphoma. Therefore, ultrasound combined with CT may be useful for distinguishing between PTL and HT.

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Section: Discussionmentioning

confidence: 99%

Is ultrasound combined with computed tomography useful for distinguishing between primary thyroid lymphoma and Hashimoto’s thyroiditis?

Luo

Huang

Zhou

et al. 2019

Endokrynologia Polska

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“…Similarly, pathologic nodes that may not be palpable on physical exam are easily apparent with US, however, these may be overlooked by an US technician, particularly if located in the lateral neck. 21 As such, we advocate for surgeon-performed US in a ubiquitous fashion throughout head & neck endocrine surgery, and not only for select cases such as those considered for TOETVA.…”

Section: Importance Of Surgeon Performed Ultrasound In Head and Neck Enmentioning

confidence: 99%

The role of surgeon‐performed ultrasound in transoral endoscopic thyroidectomy vestibular approach (TOETVA)

Razavi¹,

Shaear²,

Anuwong

et al. 2020

World j. otorhinolaryngol.-head neck surg.

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Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is a recently described surgical technique where the thyroid and central neck can be accessed without a cutaneous incision. To date nearly 700 cases have been described within the English literature demonstrating the feasibility, safety, and efficacy of the technique. As more institutions begin to adopt the surgical approach, it is important that surgeons pay close attention to appropriate patient selection and surgical optimization to prevent experience-related complications. A valuable tool to facilitate these considerations is the utilization of surgeon-performed ultrasonography (US). While the merits of surgeon-performed US are well-documented within head & neck endocrine surgery as a whole, its value may be of even greater importance when implementing a novel surgical technique such as TOETVA. Here we highlight and summarize the role of surgeon-performed US within head & neck endocrine surgery, focusing on how it may influence patient selection and surgical planning with TOETVA.

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“…Multiple studies demonstrated that radiologist-performed USs were less accurate and provided inadequate preoperative staging when compared to surgeon-performed USs (67–70). Nearly half of patients received incorrect initial surgery with high local recurrence when an operation decision was made only based on radiologist-performed USs.…”

Section: Diagnostic Accuracy Of Preoperative Usmentioning

confidence: 99%

“…Rosebel Monteiro demonstrated that metastatic lymph nodes were diagnosed more frequently by CT imaging than US (70.8 vs. 54%). Moreover, surgeon-performed US was only able to detect 45% of metastatic lymph nodes in a cohort comprised of patients with LLNM (67). In the Kuma hospital, US was performed by specially trained sonographers and retrospectively reviewed by surgeons (15).…”

Section: Diagnostic Accuracy Of Preoperative Usmentioning

confidence: 99%

Active Surveillance for Papillary Thyroid Microcarcinoma: Challenges and Prospects

et al. 2018

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Active surveillance (AS) can be considered as an alternative to immediate surgery in low-risk papillary thyroid microcarcinoma (PTMC) without clinically apparent lymph nodes, gross extrathyroidal extension (ETE), and/or distant metastasis according to American Thyroid Association. However, in the past AS has been controversial, as evidence supporting AS in the management of PTMC was scarce. The most prominent of these controversies included, the limited accuracy and utility of ultrasound (US) in the detection of ETE, malignant lymph node involvement or the advent of novel lymph node malignancy during AS, and disease progression. We summarized publications and indicated: (1) US, performer-dependent, could not accurately diagnose gross ETE or malignant lymph node involvement in PTMC. However, the combination of computed tomography and US provided more accurate diagnostic performance, especially in terms of selection sensitivity. (2) Compared to immediate surgery patients, low-risk PTMC patients had a slightly higher rate of lymph node metastases (LNM), although the overall rate for both groups remained low. (3) Recent advances in the sensitivity and specificity of imaging and incorporation of diagnostic biomarkers have significantly improved confidence in the ability to differentiate indolent vs. aggressive PTMCs. Our paper reviewed current imagings and biomarkers with initial promise to help select AS candidates more safely and effectively. These challenges and prospects are important areas for future research to promote AS in PTMC.

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Importance of surgeon-performed ultrasound in the preoperative nodal assessment of patients with potential thyroid malignancy

Cited by 20 publications

References 19 publications

Is ultrasound combined with computed tomography useful for distinguishing between primary thyroid lymphoma and Hashimoto’s thyroiditis?

Is ultrasound combined with computed tomography useful for distinguishing between primary thyroid lymphoma and Hashimoto’s thyroiditis?

The role of surgeon‐performed ultrasound in transoral endoscopic thyroidectomy vestibular approach (TOETVA)

Active Surveillance for Papillary Thyroid Microcarcinoma: Challenges and Prospects

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