Thyroid ultrasound-just do it.
Thyroid ultrasound-just do it.
复制标题
甲状腺超声检查——就做吧。
DOI：
10.1089/105072504322880319
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发表时间：
2004
期刊：
影响因子：
6.6
通讯作者：
H. Baskin
中科院分区：
文献类型：
--
作者：
H. Baskin
REAL-TIME ULTRASOUND of the thyroid and neck has been available for 25 years, but has remained amazingly underutilized by endocrinologist in the United States. This was partly because of the radiologists’ near monopoly on imaging and their lack of understanding in how ultrasound could be useful in the clinical management of patients with thyroid and parathyroid disease. It also was because of the general attitude among many endocrinologists that ultrasound had limited ability in diagnosing thyroid nodules and was even less useful for other thyroid conditions. This misconception was reinforced by a widely read article published in the 1982 Annals of Internal Medicine showing that fine-needle aspiration (FNA) biopsy was much more specific than ultrasound in separating benign from malignant nodules (1). This led to the false conclusion that FNA made ultrasound superfluous. However, some clinical endocrinologists began utilizing ultrasound in the 1990s and it was recognized that certain ultrasound characteristics of nodules (hypoechogenecity, blurred margins, microcalcifications, enlarged lymph nodes, and increased vascularity) have predictive value in determining malignancy. Marqusee et al. 2 reported in 2000 Annals of Internal Medicine that ultrasound altered the clinical management in 63% of 173 patients referred to the thyroid nodule clinic at Brigham and Women’s Hospital, making it clear that ultrasound was cost effective and complements FNA rather than competes with it. The evaluation of thyroid nodules is only one of a growing number of uses endocrinologists have found for ultrasound. One early use was in epidemiology. It was found that the volume of the thyroid in grade-school children closely correlates with the urinary iodine excretion and thus with the iodine content of the diet. This provided the World Health Organization with an easier method of mapping iodine deficient areas of the world and institute measures to eradicate endemic goiter. A more dramatic use of ultrasound occurred after the Chernobyl nuclear accident in 1986. In certain areas around the blast, the incidence of thyroid cancer in preschool children increased as much as 100-fold. In spite of thousands of cases of thyroid cancer, the mortality rate has been astonishingly low because health care workers using ultrasound screening have detected cancer early when it is most amenable to surgical cure. Had the explosion occurred a decade earlier before ultrasound was available, it is probable many more children would have died. Early detection using ultrasound did lower mortality.A seldom mentioned use of ultrasound is for defining the anatomy of the neck. Often patients present with a neck mass thought to be of thyroid origin but ultrasound quickly and easily identifies it of extrathyroidal origin. Indeed, its use as a teaching tool in medical education is sorrowfully underappreciated. I have found that a third-year medical student can be brought to the level of an endocrine fellow after 2 days of neck examinations followed by ultrasound followed by reexaminations. To try and teach physical examination of the neck without ultrasound is analogous to teaching examination of the heart without a stethoscope. The value of neck ultrasound is only exceeded by its use when combined with FNA. Real-time ultrasound guidance has technically refined the FNA technique. Numerous investigators have shown that ultrasound-guided FNA decreases the number of inadequate specimens from 15–20% to less than 5%(3–5). Others have shown that it also increases sensitivity and specificity over conventional FNA (6, 7). Aside from being cost effective, well tolerated, and quick …
