Ultrasound in evaluation and diagnosis of neck masses

Although the use and value of ultrasound in the evaluation and diagnosis of neck masses is well accepted by the radiology community, clinicians in the United States have not widely adopted the use of office-based ultrasound in the direct patient care setting of the clinic. European clinicians who treat disorders of the head and neck use office-based ultrasound extensively in outpatient clinics and emergency rooms.

Several roadblocks have precluded ultrasound use by clinicians in the United States. The most profound of these are the perceived steep learning curve, absence of training in head and neck ultrasound in clinical residencies, and perceived scope of practice issues with radiologists. American surgeons only recently have begun to experiment with this technology in the office, because ultrasound was traditionally perceived as difficult to interpret, inaccessible, and the “turf” of specialists in ultrasound radiology. These factors have left American clinicians, both military and civilian, relatively untrained in the use of head and neck ultrasound and totally dependent on the availability of the radiologist to perform ultrasound examinations and ultrasound-guided procedures for head and neck masses and lesions.

Recent improvements in the quality of resolution of ultrasound units has rendered the interpretation of ultrasound images much easier, with results that approach the clarity of CT scanning at a fraction of the cost and time. Head and neck ultrasound training and instructor training courses are also now offered at medical meetings in the United States. The combination of the increased ease of use of contemporary ultrasound units and the availability of surgeon-instructors has finally engendered guarded interest among clinicians. Of similar importance, the cost of portable ultrasound machines with excellent resolution and straightforward functionality has recently decreased, making them now affordable for most office practices.

Given the recent improvements in ultrasound resolution and the affordability of portable ultrasound units, clinician-performed head and neck ultrasound now offers otolaryngologists the opportunity to improve the quality and efficiency of patient care in several ways. This article introduces some of these methods, with much more in-depth discussions provided in other articles elsewhere in this issue.

Office-based ultrasound

Contemporary portable ultrasound units have become smaller, much easier to interpret, and less expensive, with many models costing less than $30,000. This improved accessibility of ultrasound technology has enabled clinicians to finally have a tool that improves the physical examination of patients, literally enabling clinicians to see what lies beneath the skin during an initial patient evaluation. Clinicians are now able to accurately risk-stratify thyroid nodules based on their appearance on ultrasound, complementing the information obtained on fine needle aspiration biopsies. Furthermore, subcutaneous masses, such as adenopathy or abscesses, can be accurately diagnosed, followed up, or treated, helping otolaryngologists to quickly and inexpensively formulate the most appropriate management course.

In the past, most otolaryngologists would immediately order a CT, MRI, or radiologist-performed ultrasound scan on diagnosing a neck mass. This prescription would often require patients to wait days to weeks for the imaging to be scheduled, performed, and interpreted before they could return to the office for a follow-up appointment to discuss the disease process. Now, an ultrasound can be immediately performed by otolaryngologists during the initial visit, allaying patient anxiety and obviating any delays in treatment.

Office-based ultrasound

Contemporary portable ultrasound units have become smaller, much easier to interpret, and less expensive, with many models costing less than $30,000. This improved accessibility of ultrasound technology has enabled clinicians to finally have a tool that improves the physical examination of patients, literally enabling clinicians to see what lies beneath the skin during an initial patient evaluation. Clinicians are now able to accurately risk-stratify thyroid nodules based on their appearance on ultrasound, complementing the information obtained on fine needle aspiration biopsies. Furthermore, subcutaneous masses, such as adenopathy or abscesses, can be accurately diagnosed, followed up, or treated, helping otolaryngologists to quickly and inexpensively formulate the most appropriate management course.

In the past, most otolaryngologists would immediately order a CT, MRI, or radiologist-performed ultrasound scan on diagnosing a neck mass. This prescription would often require patients to wait days to weeks for the imaging to be scheduled, performed, and interpreted before they could return to the office for a follow-up appointment to discuss the disease process. Now, an ultrasound can be immediately performed by otolaryngologists during the initial visit, allaying patient anxiety and obviating any delays in treatment.