Usefulness of ultrasonography in the management of nodular thyroid disease

Background: Fine-needle aspiration biopsy is the standard diagnostic test f or evaluating possible malignancy in a thyroid nodule Objective: To evaluate the role of routine ultrasonography in the managemen t of nodular thyroid disease. Design: Retrospective chart review. S etting: Multidisciplinary thyroid nodule clinic (endocrinology and radiolog y). Patients: Patients with suspected nodular thyroid disease or suspected recu rrent thyroid cancer referred between October 1995 and March 1997. All pati ents had thyroid ultrasonography and ultrasonography-guided fine-needle asp iration 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 compare d with the referring physician's findings on physical examination. Results: 223 patients were seen in the clinic. A total of 209 fine-needle a spiration biopsies were performed on 156 patients. Among 50 of 114 patients referred for a solitary nodule, ultrasonography detected additional nonpal pable nodules at least 1 cm in diameter in 27 and determined that no nodule s required aspiration in 23. Of 59 patients referred for a diffuse goiter o r a multinodular gland, ultrasonography detected discrete nodules at least 1 cm in diameter that required aspiration in 39 and determined that aspirat ion 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.