High Resolution Neck Ultrasound and Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid
High resolution neck ultrasound (US) has revolutionized the diagnosis and treatment of thyroid and parathyroid nodular disease. In the late 1980’s, several pioneering endocrinologists across the United States began to use neck ultrasound for the evaluation and biopsy of small thyroid lumps that could not be felt by hand. Over the next 20 years, ultrasound resolution capabilities have improved so much that parathyroid tumors underneath the thyroid and deep in the neck can actually be seen.
In addition, clinical endocrinologists have come to realize that because they have a comprehensive knowledge of all the patient’s historical data, physical examination details and other laboratory testing, they can do a better job of finding thyroid and parathyroid nodules than anonymous ultrasound technicians operating in hospital centers without all the appropriate clinical information. This has led to the recruitment of a new generation of endocrinologist ultrasonographers who are using neck ultrasound in inventive ways to diagnose and treat thyroid and parathyroid disease. Dr. R. Mack Harrell is one of these pioneers.
Since introducing office-based neck ultrasonography to the Cleveland Clinic Foundation in 1991, Dr. Harrell has performed over 5000 neck ultrasounds in patients with thyroid and parathyroid disease. In 2006 alone, he personally conducted over 700 ultrasound evaluations of neck endocrine structures. Dr. Harrell does not employ an ultrasound technician because he believes that the doctor making the clinical decisions should be the person who searches the neck for disease. In his opinion, the current hospital model of a technician performing the US scan and a radiologist remotely interpreting the pictures leads to mis-communication and inadvertent oversight errors.
Using his Siemens office-based high-resolution ultrasound probe, Dr. Harrell is able to find parathyroid enlargement in 70% of his hyperparathyroid patients with calcium levels in excess of 11.0 mg/dl. If the in-office ultrasound parathyroid tumor location matches the out-patient Sestamibi scan, there is better than a 95% chance that the patient’s parathyroid condition will be cured with minimally invasive radioguided surgery.
In addition, Dr. Harrell uses his office ultrasound probe to guide him in performing fine needle aspiration biopsy (FNAB) of thyroid nodules to rule out thyroid cancer. With US guidance, biopsies can be obtained in less than 10 minutes without any need for injected anaesthesia agents (just a little skin numbing with a spray of cold ethyl chloride). The same procedure in a hospital radiology setting typically involves several shots of injected xylocaine for local anaesthesia and 60 minutes of special procedure time. When it comes to maximizing diagnostic efficiency in thyroid and parathyroid disease, nothing beats high resolution office-based ultrasound in the hands of an AACE-certified clinical endocrinologist.
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