2017 Section 7 Green Book

T ABLE OF C ONTENTS Selected Recent Materials - Reproduced in this Study Guide

FEBRUARY 2017 SECTION 7 NEOPLASTIC AND INFLAMMATORY DISEASES OF THE HEAD AND NECK

ADDITIONAL REFERENCE MATERIAL………………………………………..............…. i-iii

I.

Head and Neck Ultrasound Badran K, Jani P, Berman L. Otolaryngologist-performed head and neck ultrasound: outcomes and challenges in learning the technique. J Laryngol Otol . 2014; 128(5):447-453. EBM level 3............................................................................................................................1-7 Summary : This is a very compelling study describing the experience of a single otolaryngologist head and neck surgeon who follows all necessary steps to become certified in head and neck ultrasonography. The subject then reports his results as far as accuracy by referencing his first 250 patients and his interpretations of their ultrasounds. He then had his radiologist collaborator review the ultrasounds and compare accuracy rates between them. The study demonstrates that in this one individual case, the radiologist-interpreted ultrasound had a lower false-negative rate and was somewhat more accurate. The accuracy of the otolaryngologist-performed ultrasound was still very good. This study highlights the potential difficulties of attempting to train otolaryngologist head and neck surgeons to add ultrasound to their armamentarium and expect that they will perform with similar accuracy and results to radiology-trained physicians. Mazzaglia PJ. Surgeon-performed ultrasound in patients referred for thyroid disease improves patient care by minimizing performance of unnecessary procedures and optimizing surgical treatment. World J Surg . 2010; 34(6):1164-1170. EBM level 3..........................8-14 Summary : This is a single institutional experience of an individual surgeon performing in-office ultrasound and comparing his results to those of outside ultrasounds received with the patient referrals. There were 344 consecutive patients in this study. In 64 of these patients, the surgeon’s ultrasound and interpretation differed from that of the outside radiology-performed ultrasound. These results significantly and favorably affected patient care. Although not randomized, the study does argue strongly that surgeons focused on the thyroid-parathyroid axis can detect disease and determine non- surgical or surgical action at least as well or probably better than radiology-performed neck ultrasound. This study is single armed and has short follow up. Oltmann SC, Schneider DF, Chen H, Sippel RS. All thyroid ultrasound evaluations are not equal: sonographers specialized in thyroid cancer correctly label clinical N0 disease in well differentiated thyroid cancer. Ann Surg Oncol . 2015; 22(2):422-428. EBM level 3.......15-21 Summary : This is a retrospective review of the prospectively collected database at a single institution. Surgeon-performed ultrasound was compared with non-surgeon–performed ultrasound for detecting involved cervical lymph nodes in the setting of thyroid disease. In this study, the surgeon was more than twice as successful at detecting metastatic lymph node disease compared to non-surgeon ultrasonography. The surgeon-performed ultrasound directly correlated to a much lower postoperative recurrence rate. The study has some limitations in that the control group is poorly defined. The strength is that there was a significant follow-up period.