SWENT physicians are performing ultrasound–guided fine-needle aspiration of thyroid nodules.
Thyroid nodules are very common and most of them are benign. However, thyroid nodules have an overall 5–15% chance of malignancy. Workup of a thyroid nodule involves characterization of the size and nature of the nodule with an ultrasound of the thyroid. If the nodule meet size criteria based on American Thyroid Association 2015 guidelines, an FNA is recommended. An FNA involved using a thin needle under US visualization to obtain cellular material of the nodule. This material is collected on slides and in solution and then sent to a cytopathologist for evaluation. This is done in the office under local anesthesia and takes about 10-15 minutes to perform. Patients usually described mild discomfort during the procedure and minimal, if any discomfort for the next 1-2 days. Risks are very low but include a 1% chance of a hemorrhage within the thyroid. This procedure can be done on patient’s taking aspirin or other NSAIDs, but warfarin and other blood thinners (i.e. plavix and xarelto) need to be held beforehand.
Most the time the FNA results are benign. In these cases, follow-up is usually recommended with a repeat ultrasound in a year. If the nodule stable at that time, further follow-up is typically not needed. The exception would be if the ultrasound has concerning characteristics or if the patient has risks of cancer (i.e. family history of thyroid cancer, history of radiation to the neck, or fast growing nodule). Sometimes the FNA results are consistent with thyroid cancer or are very suspicious for thyroid cancer. These cases typically need surgery with thyroidectomy. There is another classification fine-needle aspiration and this is call and indeterminate nodule. This is where the cytopathologist cannot tell if the nodule is benign or suspicious for cancer. Subsequent genetic testing is performed on the sample to help clarify. Most of the time,around 70% of cases, the risk is low and the patient is safe to be observed, just as in a benign nodule. Less commonly, the indeterminate nodule genetic testing reveals a suspicious nodule in which case surgery is recommended. Rarely, the FNA results can be nondiagnostic, meaning the cytopathologist did not have enough material. These cases usually require repeat needle biopsy in about 3 months.
Your physician will review this material and the rationale for needle biopsy during her consultation and before your procedure.