Diagnostic efficacy of surgeon-performed ultrasound-guided fine needle aspiration: A randomized controlled trial
This article was presented at the 2009 AAO–HNSF Annual Meeting & OTO EXPO, San Diego, CA, October 4-7, 2009.
Received 19 August 2009; received in revised form 24 October 2009; accepted 10 November 2009.
Abstract
Objective
To evaluate the clinical efficacy of surgeon-performed, office-based head and neck ultrasound in facilitating diagnostic fine needle aspiration (FNA) of lesions in the head and neck.
Study Design
A randomized controlled trial of ultrasound-guided FNA versus traditional palpation-guided technique for palpable masses in the head and neck.
Setting
An office-based study performed in a military academic medical center.
Subjects and Methods
Eighty-one adults older than 18 years of age with a palpable head and neck mass (less than 3 cm in largest diameter) were randomized to ultrasound-guided or traditional palpation-guided FNA of a head and neck mass. Measured variables and outcomes for the study included tissue adequacy rates, tissue type, and operator variability.
Results
Following three passes using either palpation or ultrasound guidance, a comparative tissue adequacy rate of 84 percent for ultrasound guidance versus 58 percent for standard palpation was established (P < 0.014). With regard to tissue type, a statistically significant comparative diagnostic advantage for ultrasound guidance was observed in thyroid tissue while remaining statistically insignificant for lymphatic and salivary tissues. No statistical significance was found when comparing the ability of otolaryngology residents versus attending otolaryngologists to obtain ultrasound-guided diagnostic samples.
Conclusion
Office-based surgeon-performed ultrasound-guided FNA of palpable lesions in the head and neck yields a statistically significant higher diagnostic rate compared to standard palpation technique. Our institutional experience supports the utility of surgeon-performed ultrasound as a core competency in clinical practice.
Department of Otolaryngology, Tripler Army Medical Center, Honolulu, HI
Corresponding author: Eric D. Wirtz, MD, 1 Jarrett White Road, Honolulu, HI 96859-5000
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
ABSTRACT