Surgeon-performed ultrasound-guided needle biopsy of the thyroid: A safe and effective diagnostic procedure

Abstract

With the ready availability of good quality portable units, office-based ultrasound (US) is increasingly being utilized by endocrine surgeons in their daily practices, particularly in the management of thyroid patients. Ultrasound-guided fine needle aspiration biopsy (US-FNAB) of thyroid lesions is a useful interventional diagnostic technique which can be readily performed by endocrine surgeons as an office-based procedure offering significant convenience for the patient. A retrospective review of US-FNAB's performed in a single surgeon practice between 2006 and 2008 was undertaken particularly assessing the diagnostic outcomes and complication rates. Factors affecting FNAB outcome were tested using Chi-square test and significance defined as p < 0.05. A total of 128 FNABs were performed on 100 patients in the time period under review. Mean lesion size was 22 mm, and the majority were solid on US. US-FNAB had sensitivity of 85%, accuracy 75%. No complications were reported. A total of 14.8% of samples were reported as either malignant, atypical or with Hurthle cell findings. In this series of patients, 22% of cases proceeded to thyroidectomy, 46% of which yielded malignancy. The nondiagnostic rate was only 5.5%. Solid lesions < 2 cm were associated with higher nondiagnostic rate (p = 0.04). Surgeon-performed thyroid US-FNAB is a safe and effective procedure which compares favorably to radiologist-performed series and offers a convenient 'one-stop' process for patients. In this series, it was associated with a low nondiagnostic rate and a low complication rate. Surgeon-performed US-FNAB techniques can be easily acquired; however, structured training and appropriate credentialing are important for the maintenance of quality assurance standards. © Jaypee Brothers Medical Publishers (P) Ltd.