Wednesday, February 02, 2005

The Italian Thyroid Ultrasound Machine

It is 2 months since I became the 7 th thyroidologist in the USA to own the Technos Partner Biosound Esaote Small Parts ultrasound, made in Italy. The machine is awesome. I can see and biospy 5 mm suspect cancer nodes, inject saline, and alcohol in thyroid cysts,and analyze nodules for cancer characteristics. Irregular borders, vascular invasion in the nodule, as well as size and echogenicity. The picture quality is as good as the $200,000 all purpose machine they make. I am finding more suspicious neck nodes with this machine, and can biopsy them as well. The guided needle into the node can be sent for cytology, but also washed into saline for Cancer markers,thyroglobulin, and calcitonin.Small suspect parathyroid masses, and cysts can be biopsied, and needle washed for parathyroid hormone. The nodule evaluation is more refined with this machine. For example, if one faces a patient with a goiter with 6 nodules, the cancer may not be the biggest or dominant one by size.This is the one we all would have biopsied in the past. By evaluating the factors most suggestive of tumor, by ultrasound, we can pick out the nodule most likely to harbor cancer, or the "real" dominant nodule. The lower risk nodules can be followed and only biopsied if they grow. The new age of thyroid evaluation for thyroid cancer by high resolution ultrasound is here. Moved to the back bench, is the old mainstay of thyriod cancer follow up, the Total Body I/131 Scan.


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