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Fine-needle aspiration biopsy (FNA) of a thyroid nodule
Short answer
Thyroid FNA is the taking of a cell sample from a suspicious nodule with a fine needle under ultrasound guidance. The goal is to find out whether the nodule is benign or malignant. Dr. Shirvan Zekeriyeyev performs the procedure personally. According to the doctor, the pain is minimal, about the same as when blood is drawn from a vein, and depends on the technique. If the patient wishes, local anesthesia can also be given.
Schematic — not a real scan image
In the doctor's practice
- How it is done. The endocrinologist performs the biopsy under ultrasound guidance. “The main thing during a biopsy is to take material from every side of the nodule”: the tip of the needle is moved to take material from the top, the bottom and all sides of the nodule. The material is smeared onto glass slides and sent to a pathology laboratory for cytological examination.
- Pain. “Pain during and after FNA unfortunately depends on the technique. When the sample is taken from the right spot and in the proper way, there is almost no pain during or after the procedure.”
- Which nodules. “Not every nodule is biopsied, and the size of the nodule is not important for a biopsy. What matters most is to correctly assess the nodule's composition and character.” Examples from the doctor's posts:
- a biopsy was done on an 8 mm nodule because of its suspicious appearance, and the result was papillary carcinoma;
- a 7.1 mm nodule in the setting of Hashimoto's was sent for biopsy because of hypoechoic areas (video);
- in a 10 mm nodule, two suspicious signs (a thick halo and being taller than wide) were enough for the decision to do a biopsy;
- in a 39-year-old male patient who had been followed for about 10 years for an “insignificant nodule,” the nodule was assessed as TIRADS-5, the biopsy result was follicular neoplasm (FN), and the next steps were planned.
- Groups that need special attention. “Thyroid nodules should be approached with more care in children (regardless of sex) and in older male patients.”
- Where. It has been done in Baku and in Gabala (Sağlam Həyat Medical Center).
Which nodules may need a biopsy
The doctor's practical guide
- If a nodule larger than 15 mm has one of these signs: hypoechogenicity, irregular margins, central blood flow, microcalcifications, being taller than wide.
- If a nodule larger than 10 mm has 1–2 of the signs above at the same time.
- Isoechoic and hyperechoic nodules larger than 20 mm.
- Nodules smaller than 10 mm but with several unfavorable signs at the same time.
The final decision is made by the endocrinologist who performs the ultrasound personally.
After the biopsy result
- If the result is benign and the nodule does not cause the patient discomfort (for example, a choking sensation), it is followed with repeat check-ups.
- If the result is unfavorable, the nodule is removed surgically; the patient is referred to a surgeon.
The doctor's note: “The idea that the answer will come back bad with every biopsy is unfounded.” In most patients who are diagnosed with cancer by biopsy and operated on, the outcome is encouraging, because most thyroid cancers are slow-progressing.
Myths
“It shouldn't be touched,” “if you put a needle in, it will spread,” “it is painful” — in the doctor's words, these are “unproven statements and myths.” “Think about a biopsy the same way you think about giving blood, and listen to your doctor's advice.” On the contrary, if a nodule is malignant, a biopsy helps to make the diagnosis before it spreads.
General information
After the procedure, there may be mild pain or a small bruise at the needle site; these usually go away on their own.
Q&A
Is a thyroid biopsy painful?
According to the doctor's explanation, the pain is minimal, about the same as when blood is drawn from a vein, and depends on the technique. If the patient wishes, local anesthesia can be given.
Can a nodule “spread” after a biopsy?
No. Ideas such as “a malignant process spreads when it is touched” and “you must not put a needle into a nodule” are unfounded.
Does a large nodule always need a biopsy?
No. The decision to do a biopsy is made based on the ultrasound characteristics of the nodule, not on its size. A small nodule can be suspicious, while a large nodule may not require a biopsy.