Position Statement: Surgeon Performed Neck Ultrasound

The AAO-HNS supports surgeons performing ultrasound of the head and neck, including ultrasound-guided fine needle aspiration for diagnostic purposes. Neck ultrasound is not an extension of the physical exam, but rather a discrete diagnostic procedure.

Drafted 11/11/2015
Submitted for Review 11/30/2015
Adopted 3/20/2016
Reaffirmed 6/9/2021

References:

1. Aliyev S, Agcaoglu O, Aksoy E, et al. An analysis of whether surgeon-performed neck ultrasound can be used as the main localizing study in primary hyperparathyroidism. Surgery. 2014;156(5):1127-1131.
2. American Medical Association. H-230.960 Privileging for Ultrasound Imaging. https://www.ama-assn.org/ssl3/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=/resources/html/PolicyFinder/policyfiles/HnE/H-230.960.HTM
3. Arora S, Balash PR, Yoo J, Smith GS, Prinz RA. Benefits of surgeon-performed ultrasound for primary hyperparathyroidism. Langenbecks Arch Surg. 2009 Sep;394(5):861-867
4. Aspinall SR, Nicholson S, Bliss RD, Lennard TW. The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice. Ann R Coll Surg Engl. 2012;94(1):17-22.
5. Beggs AD, Thomas PR. Point of use ultrasound by general surgeons: review of the literature and suggestions for future practice. Int J Surg. 2013;11(1):12-17.
6. Bernier-Jean A, Albert M, Shiloh AL, et al. The diagnostic and therapeutic impact of point-of-care ultrasonography in the intensive care unit. J Intensive Care Med. 2015 Sep 30. pii: 0885066615606682. [Epub ahead of print]
7. Bhatki AM, Brewer B, Robinson-Smith T, Nikiforov Y, Steward DL. Adequacy of surgeon-performed ultrasound-guided thyroid fine-needle aspiration biopsy. Otolaryngol Head Neck Surg. 2008;139(1):27-31.
8. Boneti C, McVay MR, Kokoska ER, Jackson RJ, Smith SD. Ultrasound as a diagnostic tool used by surgeons in pyloric stenosis. J Pediatr Surg. 2008;43(1):87-91.
9. Buzzas GR, Kern SJ, Smith RS, et al. A comparison of sonographic examinations for trauma performed by surgeons and radiologists. J Trauma. 1998;44(4):607-608.
10. Coltrera MD. Clinician-performed thyroid ultrasound. Otolaryngol Clin North Am. 2014;47(4):491-507.
11. Dehqanzada ZA, Meisinger Q, Doucet J, et al. Complete ultrasonography of trauma in screening blunt abdominal trauma patients is equivalent to computed tomographic scanning while reducing radiation exposure and cost. J Trauma Acute Care Surg. 2015;79(2):199-205.
12. Deutmeyer C, Weingarten M, Doyle M, Carneiro-Pla D. Case series of targeted parathyroidectomy with surgeon-performed ultrasonography as the only preoperative imaging study. Surgery. 2011;150(6):1153-1160.
13. Gallagher PV, Elliott ST, Charnley R. Appraising surgeons learning sonography: measuring measurement variability. J Clin Ultrasound. 2003 Sep;31(7):364-368.
14. Gu WX, Tan CS, Ho TW. Surgeon-performed ultrasound-guided fine-needle aspiration cytology (SP-US-FNAC) shortens time for diagnosis of thyroid nodules. Ann Acad Med Singapore. 2014;43(6):320-324.
15. Gurney TA, Orloff LA. Otolaryngologist-head and neck surgeon-performed ultrasonography for parathyroid adenoma localization. Laryngoscope. 2008;118(2):243-246.
16. Henry-Tillman R, Glover-Collins K, Preston M, et al. The SAVE review: sonographic analysis versus excision for axillary staging in breast cancer. J Am Coll Surg. 2015;220(4):560-567.
17. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope. 2011;121(3):487-491.
18. Hwang HS, Perez DA, Orloff LA. http://www.ncbi.nlm.nih.gov/pubmed/19688854 Laryngoscope. 2009;119(10):1958-1965.
19. Layeequr Rahman R, Crawford S, Hall T, Bavosi D, Quinlan R. Surgical-office-based versus radiology-referral-based breast ultrasonography: a comparison of efficiency, cost, and patient satisfaction. J Am Coll Surg. 2008;207(5):763-766.
20. Lee CY, Snyder SK, Lairmore TC, Dupont SC, Jupiter DC. Utility of surgeon-performed ultrasound assessment of the lateral neck for metastatic papillary thyroid cancer. J Oncol. 2012;2012:973124. Epub 2012/02/01. doi: 10.1155/2012/973124.
21. Lee L, Steward DL. Sonographically-directed neck dissection for recurrent thyroid carcinoma. Laryngoscope. 2008;118(6):991-994.
22. Lee L, Steward DL. Techniques for parathyroid localization with ultrasound. Otolaryngol Clin North Am. 2010;43(6):1229-1239.
23. Oltmann SC, Schneider DF, Chen H, Sippel RS. All thyroid ultrasound evaluations are not equal: sonographers specialized in thyroid cancer correctly label clinical N0 disease in well differentiated thyroid cancer. Ann Surg Oncol. 2015;22(2):422-8.
24. Robitschek J, Straub M, Wirtz E, Klem C, Sniezek J. Diagnostic efficacy of surgeon-performed ultrasound-guided fine needle aspiration: a randomized controlled trial. Otolaryngol Head Neck Surg. 2010;142(3):306-9.
25. Roe SM, Mathews JA, Burns RP, et al. Stereotactic and ultrasound core needle breast biopsy performed by surgeons. Am J Surg. 1997;174(6):699-703.
26. Rozycki GS, Ochsner MG, Schmidt JA, et al. A prospective study of surgeon-performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma. 1995;39(3):492-498.
27. Ryan WR, Orloff LA. Intraoperative tumor localization with surgeon-performed ultrasound-guided needle dye injection. Laryngoscope. 2011;121(8):1651-1655.
28. Soon PS, Delbridge LW, Sywak MS, et al. Surgeon performed ultrasound facilitates minimally invasive parathyroidectomy by the focused lateral mini-incision approach. World J Surg. 2008;32(5):766-771.
29. Steward DL, Danielson GP, Afman CE, Welge JA. Parathyroid adenoma localization: surgeon-performed ultrasound versus sestamibi. Laryngoscope. 2006;116(8):1380-1384.
30. Testa A, Francesconi A, Giannuzzi R, Berardi S, Sbraccia P. Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department. Intern Emerg Med. 2015 Oct 8. [Epub ahead of print]
31. Tsao GJ, Orloff LA. Clinician-performed thyroid ultrasound-guided fine-needle aspiration. Otolaryngol Clin North Am. 2014;47(4):509-518.
32. Ultrasound Examinations by Surgeons. American College of Surgeons Committee on Emerging Surgical Technology and Education. https://www.facs.org/about-acs/statements/31-ultrasound-exam. June 1, 1998.
33. Whitehouse PA, Baber Y, Brown G, et al. The use of ultrasound by breast surgeons in outpatients: an accurate extension of clinical diagnosis. Eur J Surg Oncol. 2001;27(7):611-616.
34. Yeh MW, Bauer AJ, Bernet VA, et al. http://www.ncbi.nlm.nih.gov/pubmed/25188202. Thyroid. 2015;25(1):3-14

Important Disclaimer Notice (updated 7/31/14)

Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.