2017 Section 7 Green Book

ABLE OF

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

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.