[SURGEON PERFORMED THYROID AND NECK ULTRASOUND AS A TOOL FOR BETTER PATIENT CARE]

Surgeon performed ultrasound (SUS) has become a valuable tool for the head and neck/endocrine surgeon. It allows for a complementary examination of the neck, following history and physical examination. With its reduced costs and being radiation free, US has become the modality of choice for imaging thyroid, parathyroid and lymph nodes of the neck. In thyroid cancer, the role of US has constantly grown, as reflected in the latest American Thyroid Association (ATA) guidelines: The shift from whole body iodine scans to US has allowed for surveillance in low risk patients who underwent thyroidectomy, follow-up of microcarcinomas, and has a key role in the assessment of a thyroid nodule following initial aspiration. However, US is still limited by operator dependent inherent flaws, which are reflected by a relatively moderate inter-observer agreement, even among experts. When conducted by the same surgeon, SUS allows the patients to enjoy the benefits of US while overcoming this limitation. When compared to radiologist-performed US, several studies have shown that high volume surgeons can reach non-inferior predicative values for malignant nodules, using accepted suspicious sonographic features such as solid texture, hypoechogenicity, microcalcifications, irregular margins and taller rather than wider shape. Several studies have tried to answer the most important utility of SUS - its ability to change the course of management of the cases. In all studies SUS was able to change the management of the cases in 17-45% of the patients, extending surgery in some patients while avoiding unnecessary dissections in others. In summary, SUS is an important, feasible tool for the head and neck and endocrine surgeons. Studies have shown that high volume surgeons can reach excellent rates of prediction and detection, thus saving the patients unnecessary clinic visits, tension and additional imaging, and can even directly influence the management of the patients.