Office Ultrasound & Guided Fine Needle Aspiration Biopsy
Daniel Kuriloff MD, FACS has the capability of rapidly diagnosing the specific nature of a neck mass in his office, expediting proper treatment in the majority of cases, and eliminating the fear of cancer for many.
Evaluation of a Neck Mass
Most neck lumps are painless, often have no associated symptoms, yet potentially represent a life-threatening cancer or infection. Some neck masses, on the other hand, are benign cysts that may require no treatment other than the fine needle aspiration procedure itself. A more complete evacuation of the fluid may be achieved when ultrasound is utilized, and often the cyst may never recur. Some masses represent benign tumors or reactive, inflamed lymph nodes that may not need further treatment, other than periodic examination for signs of change or growth.
Ultrasound Technology
High resolution ultrasound technology has become a routine extension of the surgeon’s hands during the physical examination. It is the new “gold standard” for evaluation of thyroid, parathyroid, and other neck pathology. Since there is no ionizing radiation exposure or other known side effects from high frequency sound wave energy, the technology is safe. The high resolution of ultrasound allows for the detection of pea-sized tumors (3 mm), larger, deep lying tumors, or those in thick necks that would have escaped detection by the most skilled clinician. Ultrasound also permits 3 dimensional imaging in real time. The vascularity (degree of blood flow) can be measured within and around tumors to aid diagnosis and avoid bleeding or other potential risks during guided fine needle aspiration biopsies. A benign cyst can often be distinguished from a malignant tumor even without a needle biopsy. Small benign tumors can be followed for growth or change at defined intervals with a high level of precision.
Indications for Ultrasound Guided FNAB
The American Thyroid Association, the Academy of Clinical Thyroidologists and a collaborative effort of the American Association of Clinical Endocrinologists and the Associazione Medici Endocrinologi have recommended that a nodule of any size with sonographically suspicious features should be considered for FNAB. Sonographically suspicious features include microcalcifications, hypoechoic (less dense) solid nodules, irregular/lobulated margins, increased intra-nodular blood flow, and lymph node metastases (or signs of spread beyond the shell of the nodule). The sonographic examination is important, because physical examination alone can be imprecise in determining nodule size, its origin from the thyroid rather than adjacent tissues, and the degree of cystic change. Ultrasound guided FNAB is acceptable and is preferred for nodules that are not palpable, >25% cystic or have been biopsied before and yielded a non-diagnostic result. In one study, re-evaluation of patients using ultrasound guided FNAB for those with initially benign results on palpation-guided FNAB, led to the reclassification of patients and the diagnosis of 14% more cancers.
Surgeon Performed Ultrasound
Dr. Daniel Kuriloff received special training and certification in Head & Neck Ultrasound & Fine Needle Aspiration Biopsy through the American Association of Clinical Endocrinologists in 1995. Since then, he has acquired a huge experience performing ultrasound guided FNABs on a daily basis. Dr. Kuriloff has perfected a technique that involves a thorough sampling of multiple areas of the nodule in question. A surgeon-performed ultrasound adds a greater level of precision to the study because of an expert knowledge of regional surgical anatomy. In Dr. Kuriloff's hands, ultrasound guided FNAB will correctly diagnose 90% of all neck masses.
Advantages of Ultrasound Guided FNAB
The use of FNAB often eliminates the need for more invasive open surgical procedures in the hospital, along with the potential for bleeding, infection and unsightly scars. More importantly, using this technique can prevent the spread of cancer by allowing the earliest possible treatment while the cancer is still in its most curable stage.
The Procedure
Fine needle aspiration biopsy (FNAB) is a simple, safe, rapid office procedure that has revolutionized the diagnosis of swellings or lumps in the neck. However, performing the procedure requires training, skill and practice as the diagnosis can be missed if the wrong area, or an inadequate amount of tissue is sampled. Without the use of ultrasound guidance, FNAB is a blind procedure that may not sample the actual cancerous area, giving the false impression that a mass is benign. Fluid containing areas within a nodule, from degeneration of tissue or spontaneous internal bleeding, may contain little if any cells and the actual cancer cells may be hiding within the wall of the cyst. Without an ultrasound guided FNAB, the cancerous cells would be impossible to find. The number of non-diagnostic biopsies, due to inadequate sampling, has been drastically reduced when performed with ultrasound guidance. The procedure takes only a few minutes, with virtually no adverse effects. Since a needle the same size or smaller than that used to draw blood samples is employed, there is no significant risk of seeding cancer cells along the path of the needle or significant complications. Pain is minimized by the use of both topical and local anesthetic. One can resume normal activities immediately following the procedure. An accurate diagnosis is rendered by world-class cytopathologists on
Dr. Kuriloff's team, and results are available within several business days.
For more information regarding ultrasound guided FNAB call Dr. Kuriloff at 212-262-5555 .