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What Is Fnac Test In Thyroid

How Is A Thyroid Fna Performed

FNAC-Thyroid Gland

The neck will first be cleaned with an antiseptic. A local or topical anesthetic may be applied. For the biopsy, your doctor will use a very thin needle to withdraw cells from the thyroid nodule. The needle used is smaller in diameter than those used in most blood draws. Your doctor will insert the needle through the skin and into the thyroid nodule. After the sampling, which only takes several seconds, the needle will be removed. New needles are used for additional samples. Several samples of cells will be obtained, by sticking a fine needle in various parts of the nodule usually between two and six times . This assures a better chance to find cancerous cells if they are present. If there is fluid in the nodule, a syringe may be used to drain it.

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

Are There Any After Effects Of A Thyroid Fna

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.

What Are Thyroid Nodules

The thyroid gland is found in the neck just below the “Adam’s apple.” This gland is responsible for producing thyroid hormone, which is an important hormone that stimulates the metabolism of the body. Thyroid nodules are so common that up to half of all people have one, without any symptoms or effect. Like many things, the thyroid gland gets “lumpier” as we get older and the frequency of these nodules increases with age. In fact, many are found incidentally during routine examinations or radiology testing. Thyroid nodules are also more common in women than in men. Interestingly, because women have so many more nodules than men, the incidence of detected cancer is higher in women than in men by virtue of absolute numbers. However, each individual nodule is more likely to be cancerous if found in a man.

Doctors always hold a degree of concern whenever a new growth is detected on the body, regardless of the tissue involved. The concern is whether or not the growth or nodule is cancer. Fortunately, fewer than 10% of thyroid nodules are malignant. The majority of thyroid nodules are harmless growths, known as adenomas, and are contained within a capsule. Even though cancerous nodules are uncommon, the doctor will take the necessary measures to be certain.

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What Do Fnac Test Results Indicate

The results could indicate the lump to be clearly benign , clearly malignant or nondefinitive .

Disclaimer: All results must be clinically correlated with the patients complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

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What Genetic Tests Are Used For Thyroid Biopsies Of Nodules

FNAC of a Thyroid Nodule

Within the past few years, several molecular tests have become available to help determine whether some nodules are cancerous or benign. These tests look at many genes within the thyroid nodules genetic information. They are being used when a nodule biopsy comes back with a diagnosis of indeterminate. Sometimes, the person doing the biopsy will perform an additional pass of the needle to obtain material for such a test. This may be done on the first biopsy or at the time of a repeat biopsy.

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Special Preparations For Taking A Fnac Test

There are very few preparations needed for the FNAC test. You may be asked to avoid taking aspirin or other anti-inflammatory drugs before the procedure or to stop taking blood thinners a couple weeks in advance of the FNAC test. Routine blood tests are usually conducted two weeks before the procedure is scheduled.

Slides Processing Reading And Labelling

After the samples were taken, a preservative medium was added and the mixture was centrifuged. Samples were then analysed using liquid based cytology techniques. This was followed by the staining process, where two slides are prepared with Papanicolaou’s and May-Grunwald Giemsa stains. Results are reported using the British Thyroid Association guidelines . Specimens are considered adequate if they contain six or more groups of over 10 thyroid follicular cells, but the balance between cellularity and colloid is more important . The FNAC was categorised as non-diagnostic Thy1 when samples do not meet the aforementioned criteria or where technical artefact precludes interpretation. The final histopathology diagnosis of the surgical specimen was based on WHO criteria.

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Significance Of Non Diagnostic Fnac

There has been debate over the significance of non diagnostic FNAC. The overall rate of malignancy in thyroid non diagnostic FNAC ranges between 1.7% to 11.3% in the literature . We report a rate of 4.5% histologically confirmed malignant results, with comparable rates reported in other studies , . The malignancy rate would be higher if incidental papillary thyroid microcarcinomas are included. We believe that incidental papillary microcarcinoma detected on post operative histology should be excluded as these lesions are not detected or sampled pre operatively . The inclusion of these tumours may introduce bias to the results. For example, Oertel et al reported a 3.4% overall rate of malignancy in non-diagnostic FNAC. This rate increased to 11% if incidental papillary thyroid microcarcinomas were included. Therefore, it is important that authors document this when reporting and calculating the overall rate of malignancy.

The rate of non diagnostic FNAC has a very wide range in literature . The reasons for this are variable and beyond the scope of this paper, however, we reported the results of FNAC prepared using liquid base cytology which is reported to have less non diagnostic rate compared to conventional cytology results , .

Why Would My Doctor Refer Me To Have This Procedure

Role of FNAC Test in Thyroid

The most common reason for people to have thyroid FNA is to find out the cause of a thyroid lump . The nodule might be something that you or your doctor have noticed because:

  • You can see or feel a lump in the front of the neck in the area of the thyroid.
  • You have general swelling in the thyroid area and your doctor sent you to have an ultrasound examination that showed one or more nodules in the gland.
  • You had a thyroid problem detected while having a scanning test for other reasons.

The most common tests that show thyroid nodules are:

  • ultrasound of the neck
  • computed tomography scanning that includes the neck or PET CT scanning of the whole body
  • nuclear medicine scanning of the thyroid.

In all of these cases, thyroid FNA is carried out to discover the cause for one or more nodules in the gland. Thyroid nodules are extremely common, being found on ultrasound in up to approximately 50% of adults. Palpable nodules are much less common, being present in approximately 5% of women and 1% of men.

Nodules are generally nothing to worry about and are more common in people born and raised in areas a long way from the coast, where the soil tends to be deficient in iodine. People living in these areas may have an iodine deficient diet. Iodine deficiency can make the thyroid gland get bigger . In some cases, this enlargement is a result of growth of one or more nodules in the gland.

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Why Is An Fnac Test Performed

FNAC test is performed to determine the nature of superficial lumps- both palpable and impalpable , such as those on breast or neck.

It is specifically recommended when an abnormal lump is felt or detected during other diagnostic and routine medical procedures. Unlike its predecessors, FNAC test is non-invasive that is not associated with complications, such as scarring and pain.

Also, the needle used in FNAC is extremely fine, with a hollow interior, compared to the regular needles used for drawing blood.

Can Isoechoic Thyroid Nodule Of 7mm Be Diagnosed By Fnac Test

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Diagnostic Value Of Fnac And Dpo

The analysis of diagnostic value included 961 patients in the surgical and clinical observation groups combined. Of these, 279 patients underwent surgery and 268 were found to have malignancy at the nodule. For these surgeries, we had results of both preoperative FNAC and BRAFV600E mutation analysis. Among the 268 thyroid malignancies were 263 PTCs, four FTC, and one MTC. Of the 11 surgically proven benign nodules, eight were nodular hyperplasias and three were follicular adenomas. The remaining 682 patients had thyroid nodules that were benign by FNAC analysis and negative for the BRAFV600E mutation. We observed these patients for at least 6 months by either repeat ultrasound-guided FNAC or USG follow-up and found no changes to alter the benign status of the nodules. We therefore included these 682 patients as true negatives in the evaluation of diagnostic values. The sensitivity of FNAC alone was 67.5% and the specificity was 100%. Adding the molecular test to FNAC significantly improved sensitivity, from 67.5 to 89.6%, and accuracy from 90.9 to 96.6% . Thirteen patients presented nodules with benign or inadequate FNAC but positive results for BRAFV600E by DPO-based multiplex PCR analysis. These patients underwent thyroidectomy and nine showed PTC in the final histology .

Diagnostic values for FNAC and BRAFV600E analysis in FNA specimens of thyroid nodule in a BRAFV600E-prevalent population

Diagnostic modality .

How Is A Fnac Test Conducted

Fnac Test For Thyroid Procedure

The FNAC test is a simple procedure that is usually conducted in your physicians office, the hospital, or an outpatient clinic. The patient usually experiences no trauma and no side effects. It may be performed by a pathologist, a surgeon, or another doctor who has received training in the procedure.

Before the test begins, your vital signs will be checked and you may have an intravenous line inserted. If you are very anxious, a sedative may be delivered through this line. For those who are calmer, an oral sedative may be all that is necessary.

At the beginning of the test, the skin at the location will be cleaned with antiseptic solution and sterile drapes or towels will be placed around the test site. An injection of a local anesthesia may be administered. If this is a FNAC test for neck lumps, youll be asked to lie on your back with a pillow placed under your shoulders and your head tipped back. The doctor may request the use of ultrasound to see the right location to perform the test, especially if the lump is located deep under the skin. You will need to hold still throughout the procedure.

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How Is An Fnac Test Performed

Before the actual procedure is done, your doctor will ask you about the location of the lump and when did you first become aware of it. He/she will also inquire whether the lump feels painful or heavy.

Next, he/she will check for the lump manually to understand its location or dimension. Thereafter, the actual procedure is performed.

The skin where the test needs to be performed will first be sanitised with an antiseptic solution. If the lump is palpable, your doctor will press over the area gently to identify the spot through which the needle needs to be inserted. If, however, the lump cannot be felt, an ultrasound will be done to locate the area for needle insertion.

Once the lump is identified, your doctor will firmly hold it with one hand, and insert the needle with gentle pressure to withdraw the sample.

Usually, 2-3 samples are required to make a diagnosis. Hence, the lump that needs to be tested is fixed between the fingers as the sample is drawn.

The entire procedure does not take more than 20-40 seconds. The needle will be taken out gently before blood is observed in it. The collected sample will be sent to a laboratory for analysis, and the results should be available in 3-4 days.

This test has no complications when performed by an experienced and skilled practitioner. The only thing one might notice is slight bruising or short-lived tenderness in the area.

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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How Do I Prepare For A Thyroid Fine Needle Aspiration Biopsy

There is very little you need to do to prepare for a thyroid fine needle aspiration biopsy. Ask your healthcare provider whether you should stop taking any medicines before the procedure, like blood thinners. You should be able to eat and drink normally before the procedure. You will probably go to a medical clinic to have the procedure performed. You should be able to go home that same day.

Detection Of The Brafv600e Mutation

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DPO-based multiplex PCR analysis

The BRAFV600E mutation was detected by DPO technology using the Seeplex BRAF ACE detection system . This DPO-based multiplex PCR analysis can reportedly detect the presence of BRAFV600E in as few as 2% of cells in a wild-type population . Although allele-specific PCR is more sensitive than direct sequencing for detecting small numbers of mutant cells, it is limited by low specificity in discriminating single-base point mutations. In DPO technology, five successive deoxyinosine linkers were used for 3-end sensitization of the primer to enhance the specificity for single-base substitution. The shorter 3-portion is linked to the longer 5-portion by five successive deoxyinosine linkers. The binding energy of the shorter 3-portion alone is sufficiently low to distinguish a single-base difference, which enhances the specificity of allele-specific PCR . In accordance with the manufacturers instructions, each 20-l PCR assay contained 3 l of DNA, 4 l BRAF primer mixture, 3 l 8-methoxypsoralen solution and 10 l of Master mix . The PCR was carried out on a GeneAmp PCR System 9700 with an initial denaturation step at 94 C for 15 min followed by 35 cycles and a final extension cycle at 72 C for 10 min. Amplicon products from the DPO-based multiplex PCR were visualized and analyzed on the ScreenTape system .

Direct sequencing analysis

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Risk Factors For Malignancy In Non

In the literature, few studies have addressed possible risk factors specific for malignancy in non-diagnostic FNAC. For example, McHenry et al identified male gender as a possible predictor of malignancy in nodules with non-diagnostic FNAC. In contrast, Mendelson et al found that male gender is not associated with high risk of malignancy and they did not find any statistically significant risk associated with radiation exposure, family history of malignancy, solitary nodule or nodule more than 3 cm. Similarly, Chow et al reported no significant correlation between pre-operative findings and risk of malignancy including the number of nodules and ultrasound characteristics as well as physical findings. Our study identified multiple nodules on ultrasound as a significant risk factor for malignancy. In addition, it also demonstrated a possible trend for males to have a higher malignancy risk compared to females. Similarly, lesions sized 4 cm were more likely to be malignant compared to those less than 4 cm as were solid lesions compared to cystic lesions but again these associations did not reach statistical significance, table 3.

Analysis Of The False

Another factor of great concern regarding false-negative diagnoses is the number of nodules, and sampling error may occur when the cells captured by the needle are not from the targeted nodule. On the basis of reviewing the 4 false-negative cases with multiple nodules in our study, we found that a benign nodule was located preoperatively, while the hidden nodule in the tumor was missed. Studies have demonstrated the high incidence of malignancy in patients with multinodular goiter compared to the general population and that the presence of multiple nodules can hamper the evaluation of the entire thyroid . Therefore, false-negative results may arise due to heterogeneity within the targeted nodule or among diverse nodules, so multiple passes should be performed in various parts of a large nodule or from different nodules to reduce the risk of false-negative findings owing to heterogeneity.

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