American Association of Endocrine Surgeons- Annual Meeting Abstract Papers

ULTRASOUND FOR THE ENDOCRINE SURGEON: A VALUABLE CLINICAL TOOL TO ENHANCE DIAGNOSTIC AND THERAPEUTIC OUTCOMES
M. Milas, A. Stephen, E. Berber, K. Wagner, J. Miskulin & A. Siperstein.
The Cleveland Clinic Foundation, Cleveland, OH

Background: Surgeon-performed ultrasound (U/S) has revolutionized the subspecialty areas of trauma/ critical care, breast and vascular disease by broadening the diagnostic and interventional scope of practice. Endocrinologists are increasingly advocating routine neck U/S for better diagnosis. We report our experience on the impact of surgeon-performed U/S in an endocrine surgery practice.
Methods: Prospectively-maintained records of endocrine surgery patients seen consecutively from Nov 1999 - Nov 2004 at a tertiary care referral center were reviewed to establish patterns and outcomes of U/S practice. Surgeon-performed neck U/S was routinely done at the initial clinic visit and incorporated into resident/ fellow education.
Results: In this 5-year period, 5,703 ultrasounds were performed on endocrine patients with thyroid 42%, parathyroid 57%, and adrenal 1% disorders. Fine-needle aspiration biopsy (FNA) was performed for diagnosis in 581 patients, with low rate of initial inadequate sampling (<7%). Significant changes occurred in surgical patient management using U/S data. When U/S identified coexisting thyroid/parathyroid disease, preoperative FNA correctly established benign thyroid diagnosis, preventing 24% unnecessary thyroidectomies. Up to 33% of thyroid nodules were non-palpable by exam. With negative 99Tc-sestamibi scans, neck U/S at time of initial clinic visit identified abnormal parathyroids in an additional 86% of patients who would otherwise proceed to surgery without localized site of hyperparathyroidism. Treatment was modified in nearly 2/3 of thyroid cancer patients because preoperative U/S confirmed metastatic cervical lymphadenopathy (31%), detected recurrent disease earlier (7%), identified thyroid cancer incidentally with hyperparathyroidism (8%) or clarified it from other complex medical presentations (16%). Patients reported satisfaction with a single, comprehensive clinic visit. Residents mastered essential U/S principles and accurately defined endocrine disease after 20 neck U/S.
Conclusions: Surgeon-performed U/S is a highly specific tool for identification of endocrine disease in the neck. It is readily learned, accurately performed, and functions as an informative extension of physical examination. Because it significantly benefits patient care and impacts surgical decision-making, neck U/S is highly recommended as a valuable adjunct to endocrine surgical practice.