Can Surgeon Ultrasounds Be as Accurate as a Radiologist’s?

Can surgeon-performed ultrasounds (US) be as accurate and effective as those performed by a radiologist? A new study has a surprising answer.

The study, “Detection of rotator cuff tears by surgeon-performed ultrasound scan,” was published in the December 2020 issue of the International Journal of Orthopaedics. In it the researchers investigated whether the greatest diagnostic accuracy for the detection of a surgically relevant rotator cuff tear is provided by a scan in the radiology department, either ultrasound or magnetic resonance (MRI), or by an ultrasound scan performed in the clinic by a shoulder surgeon.

Consecutive patients scheduled for an arthroscopy for rotator cuff disease were scanned by the operating surgeon. The presence or absence of a surgically relevant cuff tear on the scan was then compared to arthroscopic findings.

Authors said, “The surgeon’s log was then compared with the radiologist results of both ultrasound and MRI performed for the same patients in our institution.” In a subgroup analysis, the results of the surgeon-performed scans were also compared to those by both specialist and non-specialist radiologists.

Overall, surgeon-performed ultrasound scans on 88 shoulders were compared to 57 departmental magnetic resonance scans and 41 departmental ultrasound scans.

According to the data collected, the surgeon-performed ultrasound scans had greater specificity (98.2 v 81.8, p = 0.08), positive predictive value (97.6 v 79.6, p = 0.010), and overall accuracy (95.0 v 84.0, p = 0.019).

No significant differences were found when comparing sensitivity (91.1 v 86.7) or negative predictive value (93.2 v 88.2).

The researchers wrote, “A surgeon performed ultrasound scan for the detection of surgically relevant rotator cuff tears can provide equal accuracy to departmental Magnetic resonance or special radiologist-performed US and better accuracy than US performed by a non-specialist radiologist. These findings support the development of ‘one stop’ shoulder clinics. To our knowledge, this is the first study to directly compare both radiology-reported US and MRI with surgeon-performed US in the same group of patients.”