Pre-Dissection Review of Ultrasound Report Increases Accuracy of Gross Thyroid Tumor Measurements.
Luisa YA Watts, Lyndsey A Emery, Antonio de las Morenas. Boston Medical Center, MA
Background: Cancer staging is invariably dependent on primary tumor size. However, discrepancies may exist between preoperative and postoperative measurements, which may affect staging. There are systematic ways in which organs are evaluated according to predetermined dissection techniques. In the thyroid, serial slices are made perpendicular to the long axis of each lobe. Measurements of lesions found are impacted by these initial incisions and may engender the discrepancy from radiographic measurements. We propose a pre-dissection evaluation of the ultrasound (US) report so that the initial cut is made into the lesion in the plane of maximum dimension.
Design: Retrospective patients were screened from our pathology database by searching total thyroidectomy specimens. Patients included in the analysis had discrete nodules measured on gross pathology as well as on US. Prospective patients were those receiving total thyroidectomies with US reports showing dominant nodules. Thyroids flagged as having dominant nodules were grossed with particular attention to the plane of maximum dimension, in that the initial cut into the lesion was made in this plane. Thus, the correlation between gross and US measurements for retrospective patients was made after gross dissection whereas for prospective patients the US measurements were used as a guide for dissection. For both retrospective and prospective patients, gross pathology measurements were compared to US measurements of the dominant nodule(s) and differences in maximum dimension were recorded.
Results: Six retrospective and six prospective patients were analyzed. The retrospective group was found to have a mean maximum difference between US and gross measurements of 0.67 cm (SD:0.4) and the prospective group 0.1 cm (SD: 0.06). Results were statistically significant with a 2-tailed p-value of 0.011 (CI: 0.161-0.972).
Conclusions: Predissection review of the US report in a patient with a dominant thyroid nodule guides pathologic evaluation to more accurately measure tumor size, which ultimately may impact patient management.
Category: Quality Assurance
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 238, Monday Morning