ACCURACY OF SURGEON-PERFORMED ABDOMINAL UTRASOUND FOR GALLSTONES
Sajjad Ahmad, Arshad Zafar, Mukhtar Ahmad, Aamir Ghafoor, Ehtisham Malik,
Adnan Ali, Umair Ahmed Saleem Qazi
Department Of Surgery,
Background: Gallstone disease is common in
Key Words: ultrasonography, cholelithiasis, surgeon, diagnosis
Gallstone disease is the most common acquired abnormality of the biliary system.1 Even experienced surgeons cannot make a confident clinical diagnosis of gallstones in patients with classical biliary symptoms and signs. A definite diagnosis requires documentation of gallstones by ultrasound, which is now a universally accepted primary imaging modality in the diagnosis of gallstones.2 It is not possible for the radiology department to do immediate ultrasound of outpatients because of increasing workloads. If a surgeon could perform and interpret ultrasound, it would enable a rapid diagnosis of gallstones in one-stop clinic and improve decision making. This study was done to evaluate the accuracy of abdominal ultrasound performed by a surgeon for detection of gallstones.
MATERIAL AND METHODS
This study was carried out at Surgical
‘A’ and ‘C’ Units of Ayub Teaching Hospital,
There were 130 female and 12 male patients. The ages ranged from 30 to 65 years. The surgeon-performed ultrasound was positive in 100 patients and negative in 42 patients. The radiologist–performed ultrasound was positive in 101 patients and negative in 41 patients. There were 100 True Positive, 41 True negative, one False Negative and zero False Positive scans yielding 99% sensitivity, 100% specificity and 99.3% accuracy. Surgeon-performed ultrasound in detecting gallstones correlated with operative findings of gallstones in 100 patients with 100% sensitivity.
Ultrasonography is a vital component of modern surgical armamentarium used in the diagnosis of many abdominal diseases3. History and physical examination alone no longer meet the surgeons’ need in the diagnosis of abdominal diseases. If a surgeon can perform and interpret ultrasound himself, it augments the physical examination. This enables a rapid diagnosis of gallstones at initial assessment which otherwise would require several visits for a definite diagnosis based on ultrasound. In this way appreciable savings can be made in patients’ waiting times and expenditure if ultrasound facilities are provided in surgical outpatients. Recent portable scanners can easily be taken to the patients at any time instead of patients visiting the radiology department. This will reduce the workloads of the radiology department.
Although abdominal ultrasonography is a skilled radiological technique, the basic principles can be readily learnt by a surgeon.4 Ultrasonography by surgeons is rapidly gaining acceptance as an effective and accurate first-line investigation in trauma, breast, thyroid, gastrointestinal tract, vascular and urological diseases.5,6 Moreover the role of surgeons in performing ultrasound is growing all over the world because of the advances in intraoperative, endoscopic and laparoscopic ultrasonography.7 These results of surgeon-performed ultrasound for detection of gallstones are good and comparable with results published in literature. In a study by Fang et al, surgeon-performed gallbladder ultrasound examination agreed with the radiologist ultrasound findings in 92% cases.8
There was only one false negative scan in this study. This scan was misinterpreted because patient was very obese and had a contracted thick-walled gallbladder with no bile. No patient was inaccurately diagnosed as having gallstones.
The results of this study indicate that ultrasound
performed by a trained surgeon can detect gallstones as accurately as by a
radiologist. The surgeons can be trained in ultrasound by arranging
comprehensive programmes in local radiology departments. The American
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4. Jang T, Aubin C, Naunheim R. Minimal training for right upper quadrant ultrasonography. Am J Emerg Med, 2004;22: 439-43
5. Rozycki GS. Surgeon-performed ultrasound: its use in clinical practice. Ann Surg 1998; 228:16-28.
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8. Fang R, Pilcher JA, Putnam AT, Smith T, Smith DL. Accuracy of surgeon-performed gallbladder ultrasound. Am J Surg 1999;178:475-9.
Address for Correspondence:
Dr. Sajjad Ahmad, Surgical ‘A’ Unit,