What is the difference between a Diagnostic Ultrasound and one done to guide the needle for a thyroid biopsy?

45 Y/O male sees me today for a second opinion. He has a large thyroid nodule, noted on
Chest Xray, and CT scans. An ultrasound guided biopsy was done.They only looked at the nodule, to aim the needles. There was no diagnostic U.S. done. When I saw him, I did the diagnostic U.S. with the new high freguency U.S. from Italy. There were multiple abnormal nodes directly next to the nodule. Some had a cystic component. These were 7-9 mm tall.They are suspicious for metastatic papillary thyroid cancer, and need to be biopsed, and a washing taken for thyroid cancer markers. His HMO failed to do a diagnostic U.S. and set him up for surgery. It is necessary to know about the nodes, BEFORE surgery, as it can change the extent of the surgery.
Beware of rushed and incomplete evaluations at HMO's, before they send you to surgery.
Anyone referred for thyroid surgery, should have a neck lymph node U.S. prior to the surgery, even when the biopsy is definitely positive for cancer. Positive nodes by node biopsy, will change the extent of the surgery to include central, and lateral neck node removal.

Dr.G.