Clinico-Pathologic Evaluation of Surgeon-Performed Point of Care Neck and Thyroid Ultrasound in A Tertiary Government Institution: A Cross Sectional Study

Abstract

Introduction: This is a cross sectional study conducted in a training hospital which seeks to evaluate the competency of surgical trainees in performing preoperative thyroid ultrasound. It aims to compare the surgeons’ ultrasound impression with the preoperative clinical diagnosis, fine needle aspiration biopsy (FNAC) findings, as well as the histopathology to determine the predictive accuracy of point of care ultrasound which can improve preoperative diagnosis and aid in surgical decision making. Methods: After a workshop on thyroid ultrasound, surgical oncology fellows and senior residents performed neck ultrasound using the ACR TIRADS criteria for describing thyroid nodules. Patients with thyroid nodules consulting from January to December 2021 were included. TIRADS score of 4 and above was used as a basis for FNAC. The histopathology was used as reference standard to determine accuracy of the US and FNAC. Results: There were 83 patients - 73 were females (87.95&) and 68 were less than 55 years old (81.93%). The agreement between clinical diagnosis and TIRADS was observed to be low (49.4%, kappa: 0.1) while the agreement between TIRADS and FNAC was moderately high (68.6%, kappa: 0.34). Clinical diagnosis alone tends to underreport malignant cases while the TIRADS score was able to correctly select the nodules which need to be biopsied. Using the TIRADS score of 4 as the cut off value, the sensitivity was 88.37% and the specificity was 43.6%. Conclusion: The study showed that surgeon performed ultrasound can improve preoperative diagnosis and can guide surgical decision making.