Surgeon-performed Ultrasound-guided Needle Biopsy of the Thyroid: A Safe and Effective Diagnostic Procedure

Abstract

With the ready availability of good quality portable units, office-based ultrasound (US) is increasingly being utilized by endocrine surgeons in their daily practices, particularly in the management of thyroid patients. Ultrasound-guided fine needle aspiration biopsy (US-FNAB) of thyroid lesions is a useful interventional diagnostic technique which can be readily performed by endocrine surgeons as an office-based procedure offering significant convenience for the patient. A retrospective review of US-FNAB's performed in a single surgeon practice between 2006 and 2008 was undertaken particularly assessing the diagnostic outcomes and complication rates. Factors affecting FNAB outcome were tested using Chi-square test and significance defined as p < 0.05. A total of 128 FNABs were performed on 100 patients in the time period under review. Mean lesion size was 22 mm, and the majority were solid on US. US-FNAB had sensitivity of 85%, accuracy 75%. No complications were reported. A total of 14.8% of samples were reported as either malignant, atypical or with Hurthle cell findings. In this series of patients, 22% of cases proceeded to thyroidectomy, 46% of which yielded malignancy. The nondiagnostic rate was only 5.5%. Solid lesions < 2 cm were associated with higher nondiagnostic rate (p = 0.04). Surgeon-performed thyroid US-FNAB is a safe and effective procedure which compares favorably to radiologist-performed series and offers a convenient 'one-stop' process for patients. In this series, it was associated with a low nondiagnostic rate and a low complication rate. Surgeon-performed US-FNAB techniques can be easily acquired; however, structured training and appropriate credentialing are important for the maintenance of quality assurance standards.

Comparison of 1869 thyroid ultrasound-guided fine-needle aspiration biopsies between general surgeons and interventional radiologists

“…[47] , a non-diagnostic rate of 6% was reported for USG-guided FNABs performed by surgeons. In the literature, the results of USG-guided FNAB range between 3.6 and 13% when performed by surgeons and between 8 and 23% when performed by radiologists [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] . In the present study, the general surgeons had non-diagnostic rates of 13%, and in the intervention group, the non-diagnostic rate was 11.4% ( Table 5 ).…”

One‐stop thyroid nodule clinic with same‐day fine‐needle aspiration cytology improves efficiency of care

“…5 These findings have been replicated in other studies. [6][7][8][9][10] In 2014, we introduced a service offering same-day surgeonperformed US-FNAC to patients requiring thyroid biopsy. The subsequent follow up appointment facilitates delivery of results and the management plan, and the extra appointment in radiology is eliminated.…”

Surgeon-performed ultrasound-guided head and neck procedures during COVID-19 pandemic

“…Traditionally, most US-guided procedures were performed by radiologists due to specific sonographic knowledge and access to ultrasound equipment [ 7 ] With the increasing popularity of high-quality smaller portable units, more and more US-related procedures are performed by surgeons in the clinic setting [ 8 ]. In the surgery literature, much has been published about the accuracy of SUS in the head and neck, particularly of thyroid nodules and salivary masses [ 9 , 10 ]. However, little has been published on the feasibility of SUS of the neck during the acute COVID-19 pandemic, particularly in countries with limited resources.…”

“…In the surgeon’s hands, ultrasound guidance is a natural extension of the physical examination, enhancing one’s capacity to detect, diagnose, and ultimately treat masses in the head and neck. It has been a decade since SUS showed a higher diagnostic rate and efficiency than a standard palpation-guided technique for head and neck masses in a randomized control trial [ 9 , 13 ]. On the other hand, the non-diagnostic rates from various surgeon performed series ranged from 3.6 to 13%, which is also favorably to a series of radiologist performed results with a range of 8 to 23% [ 14 – 16 ].…”