Real Time Neck Ultrasound
Real Time endocrine neck ultrasound with power Doppler
1. Diagnostic Ultrasound: Ultrasound utilizes harmless sound waves to produce images of the thyroid. Ultrasound exams are done in “real-time” by Dr. Hands during an office visit. The procedure is simple and painless. The patient lies flat with the neck slightly extended, transducer gel is placed on the neck and the ultrasound probe is moved over the gland and surrounding lymph nodes. By having an expert in thyroid ultrasound perform your thyroid images you will receive immediate results, a plan on how to treat your thyroid condition and biopsy at the same time if necessary.
1. Pre-operative Lymph node mapping
2. Post-operative Thyroid cancer follow-up lymph node mapping
3. Parathyroid adenomas
B. Ultrasound Guided Ultrasound FNA
FNA: (fine needle aspiration): To better assess a thyroid nodule, a biopsy is often necessary. A fine needle aspiration biopsy (FNA) uses a small needle (smaller than most blood draw needles) to obtain cell samples from the thyroid nodule. The standard of care (best practice) is to perform this function under ultrasound guidance (using the ultrasound to determine exactly where needle is going), not free hand as is done by physicians not trained in ultrasound. This ensures that the needle tip is within the targeted nodule at the time of aspiration. Dr. Hands has preformed thousands of these procedures with insufficient results in less then 1% of samples.
Local anesthesia is not necessary, as the discomfort is similar to a blood draw. The risks are minimal, including minor bruising or discomfort and does not require any special preparation (no fasting). Patients usually return home or to work after the biopsy.
2. Cancer: suspicious lymph nodes with cancer marker washings for: a. Thyroglobulin b. Calcitonin c. RPMI Flow cytometry for lymphoma
3. Suspect parathyroid adenoma with PTH washings
C. Ultrasound Guided Therapeutic Interventions:
1. Percutaneous Ethanol Injections PEI for thyroid and parathyroid cysts
2. PEI for thyroid cancer lymph node ablation
Percutaneous Ethanol Injection: This painless injection of alcohol into thyroid cysts has been a successful alternative to prevent recurrence of thyroid cysts and an alternative to surgery for recurrent cysts.
Alcohol injections have also been used as an alternative to surgery for recurrent cancer established in Lymph Nodes in the Neck. The method is effective in killing nodes with cancer and preventing continued growth. Cancer marker TG, drops after the injection and is used in patients where surgery is too risky or neck re-operation is not desired.
Dr. Hands uses ultrasound guided ethanol injections (PEI), to treat thyroid nodules that are cystic, eliminating the need for surgery. PEI can also be used to eliminate malignant lymph nodes in patients when surgery is undesired.
10. lymph node mapping pre-operatively for your surgeon, Unfortunately, many patients in the U.S. undergo thyroid cancer surgery without Preoperative Ultrasound Mapping and, in about 15% of cases, this results in leaving behind lymph nodes (LN) to which the cancer has already spread. These cancers are then “discovered” years later during cancer follow-up exams and usually require additional surgery. Pre-operative lymph node mapping will identify lymph nodes that can be biopsied to confirm metastasis which will extend the surgery to include removal of involved lymph nodes and increase chance of cure and decrease your chance of recurrence. The goal is to make the initial surgery the only surgery patients will need. Having to go back into a previously surgerized neck (for persistent disease, LN left behind) increases the risks of recurrent laryngeal nerve damage and hypoparathyroidism.
Pre-operative Ultrasound Mapping is performed for all patients undergoing surgery for suspected thyroid cancer. This method improves the care of the thyroid cancer patient through a team approach between the thyroid specialist and the surgeon to give you the best possible outcome. A map is drawn for the surgeon to guide the extent of surgery. With a Thyroid Center adjacent to the hospital, the surgeons can be present while Ultrasound is performed to visualize the abnormalities and plan the surgical approach. This gives the surgeon the exact location of metastatic nodes to facilitate a more comprehensive surgery. Removing involved nodes then facilitates I-131 treatment since macroscopic diseased nodes are resistant to treatment with I-131 Post operative surveillance of your neck is performed six months after surgery, helps determine persistence or even cure of cancer.