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How Is A Biopsy Of The Thyroid Performed

What Is A Fine Needle Aspiration Biopsy Of A Thyroid Nodule

Thyroid Nodule Biopsy

Every patient has questions when it comes to an invasive procedure. I remember my first FNA. I was very nervous, even though I knew that the doctor had years of experience. It was quick, and I was glad when it was over. It turned out to be very important that I had the procedure done, for the pathologist found cancer cells. But thats another story. Today we are talking about fine needle aspiration biopsies.

A fine needle aspiration biopsy of a thyroid nodule is a simple and safe procedure performed in the doctors office. Typically, the biopsy is performed under ultrasound guidance to ensure accurate placement of the needle within the thyroid nodule. You will be asked to lie down on your back with your head tipped backwards, so that your neck is extended. Sometimes, a pillow is placed under your shoulders to help you get in the best position for the biopsy.

During the procedure you may feel some neck pressure from the ultrasound probe and from the needle. You will be asked to remain as still as possible and avoid coughing, talking and swallowing during the biopsy.

Once the biopsy is completed, pressure will be applied to the neck. The procedure usually lasts less than 30 minutes.

Some neck discomfort at the site of the biopsy is expected following the procedure. Tylenol® and ice compresses can be used to relieve discomfort.

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What Will I Experience During And After The Procedure

During the test, you will lie on your back with a pillow under your shoulders, your head tipped backward, and your neck extended. This position makes it easier for the radiologist to access the thyroid gland.

You may feel some pressure on your neck from the ultrasound transducer and mild discomfort as the needle is moved to obtain the cells.

You will be asked to remain still and not to cough, talk, swallow or make a sound during the procedure.

Aftercare instructions vary, but generally you can resume normal activities and any bandage can be removed within a few hours.

The biopsy site may be sore and tender for one to two days. You may take nonprescription pain medicine, such as acetaminophen, to relieve any discomfort.

What Are The Benefits Of A Thyroid Fna

A FNA is a low-risk procedure that can be carried out on an otherwise healthy person in a short time as a day procedure. You can return to your normal activities within an hour of the procedure being carried out in most cases, provided these activities are not strenuous. In most cases, the FNA will tell your doctor whether or not the nodule is cancerous, but sometimes two FNA procedures are needed to finally decide this.

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What Happens To The Thyroid Tissue Obtained During A Fine

    After the procedure, the tissue obtained is prepared onto glass slides and sent to the pathologist for evaluation. First, the pathologist determines whether or not enough thyroid tissue has been obtained for analysis. After analysis, the tissue is classified. Although the classifications used by pathologists vary, the tissue is usually reported as benign; malignant; suspicious; or indeterminate. The chance of a false-negative test varies from 0%-5%, depending on where the test is performed. The chance of a false positive is less than 5% and is usually due to the presence of degenerating cells or atypical cells. These results are reported back to the doctor’s office, usually within 1 week. At this point, the doctor discusses the implications of the report and outlines further treatment, if needed based on the results.

    Are There Any After Effects Of A Thyroid Fna

    My Thyroid Biopsy Experience

    It is common to have some pain, swelling and even a little bruise where the needle was inserted into your neck. Simple pain medication available from the chemist, such as panadol or panadeine, can be taken for this. Pain and swelling should be minimal after 48 hours.

    It is important to avoid strenuous activity, particularly activity that involves bending over, straining or working over your head , as all of these activities can increase the chance of internal bleeding into the thyroid gland.

    It is uncommon to have any change in your voice, severe pain, general neck swelling, or difficulty breathing or swallowing after a thyroid FNA. If any of these things happens, you should phone the hospital or radiology practice where the procedure was carried out and let them know.

    If you are experiencing difficulty breathing after the procedure, you should go immediately to the nearest hospital emergency department.

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    Interpretation Of The Results

  • Benign Nodule; This means that cancer has been ruled out. In this case it could be due to thyroiditis, hyperplasia, fluid accumulation in form of a cyst.
  • Malignant The nodule is cancer. There are four types of thyroid malignancies.Papillary carcinoma is the most common comprising the 80% of thyroid malignancies and it tends to spread in lymph nodes. It is the easiest to treat and has very good prognosis.Follicular carcinoma appears more frequently in people living in areas with low iodide. It is more likely to spread to lungs or bones.Hurthle cell carcinoma is a type of follicular carcinoma and accounts for 3% of all thyroid cancers.Medullary carcinoma;;comprises the 4% of all thyroid cancers and is more aggressive than follicular and papillary types because it can spread to organs and nearby lymph nodes.Anaplastic carcinoma is very rare as it accounts for the 1% of thyroid malignancies. It has an extremely malignant potential and does not respond to any kind of treatment.
  • Inconclusive Diagnosis ;;The type of nodule could not be identified. This means that either the FNA should be repeated or the thyroid should be surgically removed.
  • When Would I Need A Biopsy

    A biopsy helps your doctor find the cause of a nodule or goiter. But you donât need it for all thyroid problems. For example, your symptoms, blood tests, and imaging will be enough to tell if you have Gravesâ disease.

    Your doctor will likely want to check on any nodule bigger than about 1 centimeter , especially if imaging shows that the nodule is solid, has calcium on it, and doesnât have clear borders around it.

    You might also get a biopsy without a nodule if youâre in a lot of pain and your thyroid is growing quickly.

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    Indeterminant Thyroid Nodule Biopsy: What Happens If The Biopsy Has A Result Of Undetermined Significance

    ACUS is an abbreviation for âatypical cells of undetermined significanceâ. This occurs when the thyroid FNA findings donât show for sure if the nodule is either benign or malignant. The pathologist looks at the cells and just can’t be sure if it is cancer, or non-cancer . If this happens, an option that your doctor has is to gentic testing done on the cells of the biopsy to see if there are genetic abnormalities seen. There are several commercially available tests that doctors can send the samples to determine the risk of the cells being cancerous–they look for several specific abnormal pieces of DNA that are frequently associated with thyroid cancer. Before you consider one of these genetic tests, you should ask yourself âwhat information do I seek?â and âHow will this information change my approach to my thyroid mass?â The point being, many thyroid nodule biopsies do not need this expensive genetic testing , and if the answer isn’t going to change what you are going to do, then don’t spend the extra money getting genetic testing. For example, if the thyroid nodule has other characteristics or symptoms and the plan is to have surgery to remove the nodule, then don’t bother with the genetic testing. It won’t change what you are planning on doing–you are already planning surgery.

    The Problem Of Cellular Tumors

    Preparing for your thyroid biopsy – UF Health Endocrinology in Jacksonville

    Hypercellular specimens from follicular or Hürthle cell lesions may have features suggestive of, but not diagnostic for, malignancy . Thus, the cytopathologist labels these suspicious for malignancy because cytologic features neither confirm nor rule out malignancy. Histologic examination is necessary for definitive diagnosis . Hypercellularity may be seen with nonneoplastic lesions, and Hürthle cell changes may be seen in patients with lymphocytic thyroiditis. The diagnosis of follicular neoplasm is indicative of an underlying malignancy in 14% of cases and Hürthle cell neoplasm in 15% . Many pathologists maintain that benign and malignant follicular or Hürthle cell tumors cannot be distinguished on the basis of aspirated cells only, and the lesion must be removed for histopathologic examination . However, Kini believes that follicular adenomas and follicular carcinomas usually can be differentiated on the basis of nuclear size, but Hürthle cell lesions are difficult to diagnose cytologically.


    Figure 11. Follicular neoplasm. A, Cytology shows hypercellularity, dispersed microfollicular pattern, and absent colloid. B, Thyroidectomy shows benign follicular adenoma.

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    What Is The Initial Assessment Of A Thyroid Nodule

    All patients with a thyroid nodule should undergo a complete medical history and physical examination. Specific questions regarding the onset of the nodule, related pain or discomfort, symptoms of thyroid disease, and family history are addressed. In addition, the doctor will take into account the patient’s age and sex when evaluating the possibility of malignancy. Patients with a history of head and neck radiation are at a higher risk. Cancerous nodules are also more frequent in men as compared to women. The doctor will also look for general symptoms of thyroid disease in addition to other illnesses. The size and characteristics of the nodule are assessed. Is it soft or firm? Does it move with swallowing, or is it fixed? Is there more than one nodule? Are there other nodes involved? Does it hurt when the nodule is touched? The answers to these questions will help the doctor evaluate what further investigations, if any, are necessary.

    The following is a list of factors that increase the suspicion of malignancy:

    • Age: Patients less than 30 years of age and greater than 60 years of age have a higher risk of cancer in a thyroid nodule as do children;

      The fine-needle aspiration is also performed to treat thyroid cysts. A thyroid cyst is a fluid-filled sac within the thyroid gland. Aspiration of the cyst with a needle and syringe can shrink the swelling from the cyst and the fluid removed can be analyzed for cancer.

      What To Read Next

      ThyroidCancer.com is an educational service of the Clayman Thyroid Center, the world’s leading thyroid cancer surgery center.

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      Advantages Of Needle Aspiration Biopsy

      • The results of needle biopsy of the thyroid are close to 95% accurate for adequate biopsies.
      • Needle biopsy is a reliable method of obtaining tissue samples that can help diagnose whether a nodule is benign or malignant.
      • A needle biopsy is less invasive than open and closed surgical biopsies, both of which involve a larger incision in the skin and local or general anesthesia.
      • Generally, the procedure is not painful and the results are as accurate as when a tissue sample is removed surgically.
      • Recovery time is brief and patients can soon resume their usual activities.

      Table 8when To Repeat Fna

      Multinodular goiter and solitary nodule
      • Thyroid cytology and the risk of malignancy in thyroid nodules: importance of nuclear atypia in indeterminate specimens.Kelman AS, Rathan A, Leibowitz J, Burstein DE, Haber RS. Thyroid. 2001 Mar; 11:271-7.
      • ThinPrep for cytologic evaluation of follicular thyroid lesions: correlation with histologic findings.Tulecke MA, Wang HH. Diagn Cytopathol. 2004 Jan; 30:7-13.
      • ‘Indeterminate for malignancy’ thyroid fine needle aspiration cytology reporting: morphological criteria and clinical impact.Pagni F, Prada M, Goffredo P, Isimbaldi G, Crippa S, Di Bella C, Leone BE, San Gerardo Hospital collaborators group.. Cytopathology. 2014 Jun; 25:170-6. Epub 2013 Aug 12.
      • Review Diagnosis and reporting of follicular-patterned thyroid lesions by fine needle aspiration.Faquin WC. Head Neck Pathol. 2009 Mar; 3:82-5. Epub 2009 Feb 22.
      • Review Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology.Dincer N, Balci S, Yazgan A, Guney G, Ersoy R, Cakir B, Guler G. Cytopathology. 2013 Dec; 24:385-90. Epub 2012 Oct 18.

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      How Is A Thyroid Biopsy Performed Are You Awake For A Thyroid Biopsy

      Thyroid biopsy is a minimally invasive procedure and is often done in the office setting. Patients are awake for the procedure.

      A thin needle is carefully inserted into the thyroid nodule. The needles we use are as small, or smaller, than the needles used to draw blood. Most of the time, we use ultrasound to locate the tip of the needle. The thyroid cells that become trapped inside the needle are analyzed under a microscope. At many of our sites, we examine the cells right away to ensure we have enough material for an accurate diagnosis. A single nodule may need several samples taken to have enough cells for examination. At UCLA, we always save an extra sample for molecular testing, if needed.

      After the biopsy we place a small band-aid at the needle site.;

      How Are Thyroid Nodules Treated

      All thyroid nodules that are found to contain a thyroid cancer, or that are highly suspicious of containing a cancer, should be removed surgically by an experienced thyroid surgeon. Most thyroid cancers are curable and rarely cause life-threatening problems . Thyroid nodules that are benign by FNA or too small to biopsy should still be watched closely with ultrasound examination every 6 to 12 months and annual physical examination by your doctor. Surgery may still be recommended even for a nodule that is benign by FNA if it continues to grow, or develops worrisome features on ultrasound over the course of follow up.

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      What Happens During A Thyroid Fna

      An ultrasound machine will be used to locate the nodule or nodules to be sampled and show images or pictures of the nodule or nodules onto a screen.

      The ultrasound will be carried out by a technologist or a radiologist , or both.

      The FNA procedure will then be explained to you. Instructions about what you can and cannot do after the procedure will be given to you at this time as well. You will be asked to sign a form indicating that you understand what will happen, the small risks involved, and that you agree to have the procedure done. The explanation will generally be provided by the doctor carrying out the procedure. You will have the opportunity to ask any questions at this time.

      You will generally be lying on an examination couch for the procedure.

      Your neck will be washed with antiseptic.

      The procedure is then over. The needle puncture site in your neck will be compressed for a couple of minutes by the doctor who did the FNA or a nurse who assists the doctor. An ice pack may be put on your neck to help reduce swelling and bleeding. You may be taken from the ultrasound room into an observation area for a short time to ensure that you are well enough to go home.

      History Of Thyroid Biopsy

      My first thyroid nodule biopsy with 6 needles!

      Before the invention of modern biopsy techniques such as Fine Needle Aspiration and Core Needle Biopsy, physicians sometimes had to remove a large amount of thyroid gland during surgery to make sure the patient was not at risk of malignancy. In some cases the complications of this method was required the patient to take medications and had some adverse effects. However, thanks to progress in the field, most of these complications are circumvented and now there is no need for anesthesia or surgery for biopsy.

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      What Will A Biopsy Tell Me

      Sometimes, a nodule or goiter just sits there and isnât dangerous.

      When they do cause problems, it could be something like:

      Cysts, fluid-filled nodules that can give you neck pain or make it hard to swallow. Theyâre very rarely cancer but still might need treatment.

      Gravesâ disease, which causes your thyroid to grow and make too many hormones.

      Hashimotoâs disease, where your thyroid is damaged by your immune system, so it makes fewer hormones than normal and then swells.

      Infection, where a virus causes pain and swelling in your thyroid.

      Large nodules or goiters that are an issue because of their size. They can push into surrounding body parts and make it harder to breathe or swallow.

      Toxic nodules or goiters, which are almost never cancer, can cause your thyroid to pump out too many hormones.

      Cancer, which makes up about 10% of cases.

      What Are The Risks Of A Thyroid Fna

      FNA is a very safe procedure and is considered very low risk for most people, because the needle that is used is so small.

      There are two reasonably common risks and several rare risks that you should know about. The most common risk is an uncertain diagnosis, even after the tissue sample is looked at thoroughly by the pathologist. This happens up to 20% of the time.

      The second most common risk is bleeding at the site of the FNA. This happens to approximately 1 in 10 people, and generally produces some local pain, tenderness and a lump. Simple pain medication available at the chemist is generally sufficient to help the pain and it settles with the swelling over a few days. It is best to avoid aspirin for pain relief unless you are taking this daily for other reasons. Aspirin makes it harder for blood to clot, so paracetamol is better if you need to take something for pain after the thyroid FNA.

      Major haemorrhage, enough to cause compression of your airway and problems breathing, is very rare . You need to go to a hospital emergency department immediately if this happens, and sometimes surgery is needed to stop the bleeding, but this too is very rare.

      Rarer complications after thyroid FNA include:

      If any of these things happen to you, you should see your doctor.

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