Evaluation of neck masses and cervical lymphadenopathy often requires imaging studies by computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), and/or positron emission tomography (PET). Most of these scans require that the patient be scheduled at another facility or department to have the scan performed by a technologist, await interpretation by a radiologist, and then return to the ordering physician’s office for discussion of the test results and treatment planning. Often, ultrasound-guided fine needle aspiration may be indicated, requiring yet another appointment for the patient. These multiple visits are not only inconvenient and stressful for the patient, but they tend to tie up the physician’s schedule as well. A recent study concluded that at least one of these modalities-ultrasound-can be successfully incorporated into the office setting, creating a more convenient situation for both the physician and patient, and offering a valuable and efficient diagnostic option.
Explore this issue:April 2007
The study (Akbar N, et al. Otolaryngol Head Neck Surg 2006;135;884-8) focused on the cost considerations and practical strategies for incorporating ultrasound in a head and neck practice. The authors concluded that there are significant benefits to both the patient and surgeon by having ultrasound technology available in the office. Furthermore, they found in-office ultrasound to be cost-effective, with the potential of offsetting the cost of implementing the technology within a year.
Indications and Advantages
Bert W. O’Malley Jr., MD, Professor and Chairman of the Department of Otorhinolaryngology-Head and Neck Surgery at the University of Pennsylvania Health System, has been using in-office ultrasound in his clinical practice for approximately a year. He has found having ultrasound available at the time of his examination is very beneficial in evaluating two types of lumps and bumps in the head and neck region: to further evaluate those he can palpate, and to locate and identify those he cannot palpate.
Dr. O’Malley offers the example of patients with a history of neck surgery with resulting induration making it difficult to palpate the structures. Ultrasound is more sensitive than palpation alone in differentiating between post-surgical changes and lymphadenopathy. Now that he has ultrasound available at his fingertips, Dr. O’Malley uses the technology on all of his postsurgical patients. He feels that routine use of ultrasound in these cases increases his potential for identifying recurrences earlier than if he was to follow the patient with only physical examination and periodic CT scans. It provides the physician with good information for further decision-making in cases where he or she might not have otherwise picked up on or identified something that should require further investigation. Dr. O’Malley states, Theoretically, we can catch diseases earlier, when they’re easier to treat, as opposed to later, when they are harder and more expensive to treat.