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Usefulness of Ultrasonography in the Management of Nodular Thyroid Disease

Ellen Marqusee, MD; Carol B. Benson, MD; Mary C. Frates, MD; Peter M. Doubilet, MD, PhD; P. Reed Larsen, MD, FRCP; Edmund S. Cibas, MD; and Susan J. Mandel, MD, MPH

7 November 2000 | Volume 133 Issue 9 | Pages 696-700

Background: Fine-needle aspiration biopsy is the standard diagnostic test for evaluating possible malignancy in a thyroid nodule.

Objective: To evaluate the role of routine ultrasonography in the management of nodular thyroid disease.

Design: Retrospective chart review.

Setting: Multidisciplinary thyroid nodule clinic (endocrinology and radiology).

Patients: Patients with suspected nodular thyroid disease or suspected recurrent thyroid cancer referred between October 1995 and March 1997. All patients had thyroid ultrasonography and ultrasonography-guided fine-needle aspiration biopsy of nodules at least 1 cm in maximum diameter.

Measurements: Medical records, ultrasonography findings, cytology reports, and histologic reports were reviewed. Ultrasonography findings were compared with the referring physician's findings on physical examination.

Results: 223 patients were seen in the clinic. A total of 209 fine-needle aspiration biopsies were performed on 156 patients. Among 50 of 114 patients referred for a solitary nodule, ultrasonography detected additional nonpalpable nodules at least 1 cm in diameter in 27 and determined that no nodules required aspiration in 23. Of 59 patients referred for a diffuse goiter or a multinodular gland, ultrasonography detected discrete nodules at least 1 cm in diameter that required aspiration in 39 and determined that aspiration was unnecessary in 20.

Conclusions: Ultrasonography altered the clinical management for 63% of the patients (109 of 173) referred to the thyroid nodule clinic after abnormal results on thyroid physical examination.

Author and Article Information

From Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Grant Support: By National Institutes of Health grants KO8-DK02221 (Dr. Mandel) and 5-T32-HL07609 (Dr. Marqusee) and by a Thyroid Center of Excellence grant from Knoll Pharmaceutical Co.

Requests for Single Reprints: Ellen Marqusee, MD, Thyroid Division, Brigham and Women's Hospital, Harvard Institutes of Medicine, 77 Avenue Louis Pasteur, Boston, MA 02115; e-mail, emarqusee{at}bics.bwh.harvard.edu.

Current Author Addresses: Drs. Marqusee and Larsen: Thyroid Division, Brigham and Women's Hospital, Harvard Institutes of Medicine, 77 Avenue Louis Pasteur, Boston, MA 02115.

Drs. Benson, Frates, and Doubilet: Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Cibas: Cytology Division, Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Mandel: University of Pennsylvania, Endocrine Division, G11, CRB, 415 Cune Boulevard, Philadelphia, PA 19104.

Author Contributions: Conception and design: E. Marqusee, P.R. Larsen, S.J. Mandel.

Analysis and interpretation of the data: E. Marqusee, C.B. Benson, P.M. Doubilet, P.R. Larsen, S.J. Mandel.

Drafting of the article: E. Marqusee, C.B. Benson, P.M. Doubilet, S.J. Mandel.

Critical revision of the article for important intellectual content: E. Marqusee, C.B. Benson, M.C. Frates, P.M. Doubilet, P.R. Larsen, E.S. Cibas, S.J. Mandel.

Final approval of the article: E. Marqusee, M.C. Frates, P.R. Larsen, S.J. Mandel.

Provision of study materials or patients: E. Marqusee, M.C. Frates, S.J. Mandel.

Statistical expertise: S.J. Mandel.

Obtaining of funding: P.R. Larsen, S.J. Mandel.

Collection and assembly of data: E. Marqusee, C.B. Benson, P.M. Doubilet, S.J. Mandel.

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