A fine needle aspiration biopsy (FNAB) of a thyroid nodule is the aspiration of thyroid cells with a very fine needle directly through the skin. It is an outpatient procedure and takes place in the office. The needle used is thinner than the blood collection needle and is attached to a suction syringe during the biopsy. This is a simple procedure, similar to drawing blood from your arm.
thyroid biopsy
- We performed the ultrasound-guided biopsy in our office.
- A cytologist will be present in the room to prepare and evaluate the biopsy specimens
- The average treatment time is about 30 minutes.
- We use local anesthesia (lidocaine)
- An ice pack is placed over the biopsy site for 10 minutes after the biopsy
- Patients generally do not feel pain during the procedure. If the patient is taking Coumadin, it should be stopped 5 days before the biopsy.
- If the patient is taking fish oil, vitamin E, coumadin or aspirin, these should be stopped 5 days before the biopsy.
- Someone has to pick you up and drop you off the day of your biopsy.
- You don't need any preparation: no fasting, no post-biopsy restrictions.
Ultrasound guided biopsy
ultrasound tips
Preparation of slides by a cytologist
Follow-up of patients AFTER THYROID BIOPSY
- If necessary, you can apply an ice pack for 10 to 20 minutes two or three times.
- Tylenol can be used for pain.
- 3. Call the clinic immediately if you experience neck swelling - swollen neck (large bruise), difficulty breathing, fever or chills. Our office number is 732-776-4770
- 4. The result will be available at the follow-up appointment in approximately 1 week
- 5. Bring your imaging studies: a paper copy of the film or an ultrasound CD
- 6. It is recommended to have a driver with you
Ultrasound image of a thyroid nodule in the right lobe of the thyroid
Ultrasound-guided fine needle aspiration (FNA) biopsy of the right thyroid nodule (needle bevel is indicated by arrow)
Bethesda System for Reporting Thyroid Cytology at Risk of Malignancy.
Bethesda category I.Non-diagnostic or unsatisfactory (malignancy risk 1-4%) - means there are not enough or no cells to make a diagnosis. This result would require additional testing and a repeat biopsy. If a solid nodule biopsy is diagnostic in three consecutive cases, surgery is indicated to rule out cancer.
Bethesda Category II.Benign (malignancy risk 0-3%) - means that the lump or nodule is not a malignant tumor. Although this biopsy is benign, there is still a low chance of cancer because no technique is 100% accurate. If for this reason, the patient still needs to have an ultrasound of the thyroid gland every year to ensure that there is no change in the size or appearance of the nodule.
* Bethesda Category III.Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) (malignancy risk 5-15%) - means that the result is inconclusive, although some abnormal changes are detected, but not enough to make a diagnosis of cancer. Additional tests or surgery are needed.
*Bethesda Category IV.Follicular neoplasm or suspected follicular neoplasm (risk of malignancy 15-30%) - means that the result is inconclusive, although significant changes are present even in comparison with the previous category III, but still insufficient to make a diagnosis of cancer. Additional tests or surgery are needed.
Bethesda Categoria V.Suspected malignancy (60-75% risk of malignancy) - there is a high probability of cancer and surgery is indicated.
Bethesda Category 6Malignant (97-99% risk of malignancy) - means the lump is cancerous and surgery is indicated.
[*- so called cytology unspecified]
(E.Cibas, AJCP, 2009)
Evaluation of molecular markers Genetic analysis in thyroid FNA biopsy
The revised American Thyroid Association guidelines for the management of patients with thyroid nodules and differentiated thyroid cancer (RECOMMENDATION 8; THYROID, Vol. 19, Number 11, 2009) considered the use of molecular markers (eg, BRAF, RAS, RET /PTC, Pax8/PPARg or galectin-3) in patients with indeterminate FNAC cytology to aid management (grade of recommendation: C). The guidelines state that unspecified cytology described as "follicular neoplasm" or "Hurthle cell neoplasm" occurs in 15-30% of ANF specimens and is associated with a 20-30% risk of malignancy, while lesions Reported as atypia or vesicular changes of undetermined significance are variably reported and have a 5 to 10% risk of malignancy. Although some clinical features, such as male gender and nodule size (>4 cm) (66), advanced patient age, or cytological features such as the presence of atypia, may improve the diagnostic accuracy of malignancy in patients with indeterminate cytology, in general predictive values are still short. Multiple molecular markers were evaluated to improve the diagnostic accuracy of unspecified nodules. Many of these markers are available for commercial use in reference laboratories.
I am able to perform two molecular evaluations of a routine FNA thyroid biopsy: for DNA-based markers (Asuragen) and RNA-based markers (Afirma-Veracyte):
1. Asuragen - evaluation of molecular markers
Asuragen miRInform Thyroid is a panel of molecular markers that improves preoperative diagnostic accuracy for patients with unspecified thyroid nodules. In addition, the panel can help characterize malignancy. The panel consists of 7 analytically validated molecular markers and uses fine needle aspirate (FNA) samples collected in an easy to use nucleic acid preservation solution. miRInform Thyroid can help physicians diagnose and make treatment decisions for patients.
Asuragen miRInform Molecular Marker Panel
An example of an Asuragen biopsy report
2. Affirm (Veracyte) - gene classifier
Afirm Thyroid FNA combines specialized cytopathology and the new Afirm Gene Expression Classifier (GEC). Physicians submit ANF samples of thyroid nodules collected during a single patient visit to Veracyte. Next, a thyroid cytopathologist from Thyroid Cytopathology Partners (TCP), an independent partner of Veracyte, performs a cytopathological evaluation of the FNA sample of the thyroid nodule under the microscope. If the cytopathological diagnosis is benign or malignant, the analysis is complete. Only when the cytopathologic diagnosis of TCP is indeterminate (a recent study found the indeterminate rate of TCP to be 16%) is a proprietary gene expression classifier performed.
A set of confirmatory tests
Chip Asserts for Gene Expression Classifier (GEC)
Affirms biopsy report sample
Thyroglobulin (TG) measurement in fine needle lavage fluid Lymph node biopsy
Thyroglobulin (Tg) measurement in fine needle aspiration (FNAB) samples from cervical lymph nodes is useful in the treatment of patients with papillary thyroid carcinoma when metastatic disease is suspected. The diagnosis of lymph node metastases in patients with papillary thyroid carcinoma is an important factor in the decision to perform neck dissection in the first procedure, as well as in the evaluation of lymph node enlargement after surgery.
The FNAB biopsy is performed with a single needle (25GA). The sample will then be placed in a vial and sent to the laboratory. It takes approximately 10 working days to receive the result.
The presence of thyroglobulin (TG) in a lymph node indicates metastatic disease.
Ultrasound image of metastatic cervical lymph node in a patient with papillary thyroid carcinoma
An example of a cervical lymph node FNA biopsy report in a patient with papillary thyroid carcinoma metastatic to the cervical lymph nodes.
ETHANOL ABLAATION OF THE THYROID BAG
If the thyroid nodule is completely cystic, there is the option of percutaneous aspiration and injection (ablation) of ethanol into the cyst. It is effective in treating mostly cystic nodules and sometimes requires repeated injections. The procedure is performed under ultrasound guidance, is an outpatient procedure and is performed in the office. not every patient with a cystic nodule would benefit. Only selected patients meet the criteria for ethanol ablation.
Before ethanol ablation
One year after ethanol ablation