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
Abstract
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.
Article and Author Information
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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.
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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.
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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.
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Drs. Benson, Frates, and Doubilet: Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
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Dr. Cibas: Cytology Division, Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
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Dr. Mandel: University of Pennsylvania, Endocrine Division, G11, CRB, 415 Cune Boulevard, Philadelphia, PA 19104.
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Author Contributions: Conception and design: E. Marqusee, P.R. Larsen, S.J. Mandel.
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Analysis and interpretation of the data: E. Marqusee, C.B. Benson, P.M. Doubilet, P.R. Larsen, S.J. Mandel.
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Drafting of the article: E. Marqusee, C.B. Benson, P.M. Doubilet, S.J. Mandel.
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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.
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Final approval of the article: E. Marqusee, M.C. Frates, P.R. Larsen, S.J. Mandel.
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Provision of study materials or patients: E. Marqusee, M.C. Frates, S.J. Mandel.
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Statistical expertise: S.J. Mandel.
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Obtaining of funding: P.R. Larsen, S.J. Mandel.
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Collection and assembly of data: E. Marqusee, C.B. Benson, P.M. Doubilet, S.J. Mandel.
- Copyright ©2004 by the American College of Physicians
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