Thyroid/Neck Ultrasound & Ultrasound-Guided Thyroid Fine Needle Aspiration (FNA) Biopsy

Thyroid/Neck Ultrasound & Ultrasound-Guided Thyroid Fine Needle Aspiration (FNA) Biopsy

We perform Thyroid ultrasound and Ultrasound-Guided Thyroid Fine Needle Aspiration (FNA) Biopsy at our Farmington Hills location, often the same day as your office appointment.

Thyroid/Neck Ultrasound

This simple test uses sound waves to image the thyroid. The sound waves are emitted from a small hand-held transducer which is passed over the thyroid. You will lie on your back with your neck hyperextended (with a pillow under your shoulders) as best as you can. A lubricant jelly is placed on the skin so that the sound waves transmit easier through the skin and into the thyroid and surrounding structures. This test is quick, accurate, painless, inexpensive, and completely safe. It usually takes about 10 minutes and the results can be known almost immediately. The only preparation needed for an ultrasound is to wear a low or open collar shirt (try to avoid turtlenecks) and remove any jewelry from your neck.

Ultrasound-Guided Thyroid Fine Needle Aspiration (FNA) Biopsy

Thyroid fine needle aspiration (FNA) biopsy is the only non-surgical method which can differentiate malignant and benign nodules. It is highly reliable and gives a fairly definite result. If a thyroid nodule is larger than 1 – 1.5 cm (3/8-5/8 inch) and/or has any worrisome characteristics, a fine needle aspirate biopsy is commonly recommended. In high risk patients (those who have had radiation exposure in the past or have a family member with thyroid cancer), nodules under 1 cm may need a biopsy. Using ultrasound increases the quality of the biopsy specimens and allows the doctor to know where the needle tip is at all times.

Your doctor will slide the ultrasound probe back and forth over your thyroid gland to determine precisely which area to biopsy. An injection of an anesthetic solution (lidocaine) is usually used to numb the skin first. You will feel a “pinch” and “burn” while the anesthetic begins to work. Using the ultrasound to guide the needle tip, your doctor then inserts a thin needle into your thyroid gland and removes a small amount of thyroid cells and fluid through the needle.

After each pass with the needle, the material from your thyroid gland is placed on a glass microscope slide and sent to the cytology laboratory for examination. Your doctor may perform 4-6 passes of the thyroid nodule to get an adequate specimen. During a needle biopsy, you may feel pressure or a brief, sharp pain in your neck as the needle enters your thyroid gland. Try not to swallow, cough, or make any sudden movements when the needle is in your neck to prevent injury. You do not need to hold your breath during the biopsy, but stay calm and still.

There is usually no bleeding after the procedure. A small bandage is applied where the needle was inserted. The area may remain sore for up to 24 hours after the biopsy. Ice packs relieve the pain in most cases but Tylenol can also be used. Ibuprofen should be avoided as it theoretically could increase the risk of bleeding.

Genetic Markers for Indeterminant Thyroid Nodules

Generally, the risk of thyroid cancer in any one thyroid nodule is low. When a patient has a thyroid FNA biopsy in our office with an “indeterminate” result, essentially the diagnosis is not more clear than prior to the biopsy. This can be very frustrating to the physician and the patient. Indeterminate results on thyroid FNA samples are common (5-15% of biopsies). Previous guidelines recommended that most of these nodules be surgically removed if a final diagnosis is desired.

More recent guidelines recommend genetic marker testing of these indeterminate thyroid nodules which has been shown to be cost-effective by reducing unnecessary thyroid surgeries. In our office, we offer genetic analysis testing with either Afirma Gene Expression Classifier (GEC) or Thyroseq v3.

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