Comparison between preconsultation ultrasonography and office surgeon-performed ultrasound in patients with thyroid cancer.

BACKGROUND: Cervical ultrasonography (US) is mandatory before surgery for thyroid cancer and recommended for thyroid nodule evaluation. Therefore, most patients undergo thyroid ultrasound before surgical evaluation. Several US findings are critical for adequate surgical planning but they are often not mentioned on preconsultation US. The goal of this study is to compare the preconsultation US findings with surgeon-performed US (SUS) and describe the changes in management as a consequence of SUS findings in patients with thyroid cancer. METHODS: The charts of 194 consecutive patients with thyroid cancer (2007-2013) from a single institution were reviewed. Preconsultation US and SUS reports were available for 136 patients. Mention of nodes, local invasion, thyroid nodule features/location, and presence of intrathoracic extension was recorded and changes in preoperative and/or operative management based on SUS findings were described. RESULTS: From 136 patients with the diagnosis of thyroid cancer, SUS changed the management of 61 (45 %) patients by identifying preoperatively central and/or lateral node metastasis, indicating preoperative biopsy of suspicious thyroid lesions/nodes, and pointing out thyroid intrathoracic extension. When compared to SUS, the preconsultation US failed to mention node status in 101 (74 %) patients, suspicious nodule features in 60/111 (54 %) patients with suspicious lesions, bilateral thyroid lesions in 19/88 (22 %) patients with bilateral nodules, local invasion in 5/5 (100 %), and intrathoracic extension in 5/5 (100 %) cases. CONCLUSION: Surgeon-performed US changed the operative management of patients with thyroid cancer by demonstrating additional and distinct information compared to preconsultation US in almost half of the patients. Ultrasound is more accurate and critical in the evaluation of patients with thyroid cancer when performed by the surgeon.