Explore This IssueApril 2007
-Bert W. O’Malley Jr., MD
When ultrasound is readily available and utilized at the time of initial examination, it can sometimes obviate the need for more advanced studies, such as CT, MRI, or PET. On the other hand, ultrasound may indicate that further imaging using one of these modalities is warranted, and the patient can be scheduled for these tests in a more time-efficient manner.
Otolaryngologists can use their expertise in head and neck anatomy to perform more thorough ultrasound examination of the head and neck regions. The otolaryngologist thus does not have to be limited by information provided by written reports and static images of one specific area. Real-time images offer the opportunity for the physician to immediately explore further if indicated.
Another huge advantage to having ultrasound available in the office is the ability to perform ultrasound-guided fine needle aspiration (USFNA) immediately if indicated. This offers a distinct time-saving advantage in diagnosis. The Otolaryngology-Head and Neck Surgery study indicates that USFNA has a 95.7% sensitivity and 92.9% specificity for differentiation between benign and metastatic nodes. The study further suggests that USFNA may, in some cases, preclude the need for neck dissection.
Dr. O’Malley says that his patients find it very gratifying that he is able to give them instant information. Even in cases where further diagnostic testing may be necessary, they appreciate that he is able to give them some level of on-the-spot feedback. He states, The patients love it. We can have kind of a ‘one-stop shopping.’ We can do an exam, we can do an ultrasound, and we can even biopsy.
Equipment and Cost
The physicians who participated in the Otolaryngology-Head and Neck Surgery study advised that the machine used for head and neck ultrasound and USFNA should have a transducer from 7.5 to 12 Mhz, color Doppler, and a built-in camera for capturing images. The authors determined that a system with these specifications can be purchased for between $20,000 and $40,000. There are much more expensive systems available, but the added features of these models are not necessary to perform thorough head and neck ultrasound evaluation. The more expensive models also tend to be larger and less portable than the less expensive models.