Fine Needle Aspiration Biopsy of the Thyroid

You have been found to have one or more nodules in your thyroid, a butterfly shaped gland in the lower area of the neck.  These are fairly common and about 95% of these are benign, not a cancer.  To determine which nodules need further treatment, nodules can be biopsied using fine needle aspiration biopsy techniques.  After adequate anesthesia with lidocaine injection, an ultrasound is used, and a needle is guided into the nodule and microscopic amounts of cells are harvested, placed onto glass slides and evaluated by a pathologist.  Most nodules are biopsied 5 times.  In general, nodules larger than 1 cm are biopsied, but you may have further discussions with Dr. Wolfe regarding the need to observe or biopsy specific nodules.

The risks of the procedure include bleeding and infection.  These are very rare.  It is normal to experience some mild tenderness or soreness and bruising of the surrounding area.  This is comparable to the discomfort after giving blood for a lab test.  Ibuprofen (Advil, Motrin), acetaminophen (Tylenol) and ice packs all help with the pain.  If there seems to be excessive pain and large swelling in the lower neck after the biopsy, this may indicate deep bleeding in the thyroid.  This will have to be evaluated right away.  Please call Dr. Wolfe's office at (206)505-1300.  After hours, there are doctors taking call, who can help and provide advice.

After the biopsy, the sample will be evaluated by a pathologist.  One of 4 results will be reported and further treatment is determined:

  1. Benign.  No sign of malignancy.  Follow-up will be in 6 months for surveillance.
  2. "Follicular lesion of undetermined significance.”  The pathologist has seen changes in the tissue, does not see any signs of cancer, but cannot call the nodule benign. You will be brought back into clinic to discuss the options for your nodule.
  3. Malignant or cancer.  You will come to clinic, and Dr. Wolfe will discuss treatment at length.
  4. Nondiagnostic.   The biopsy was not adequate for the pathologist to be able make a decision.  You will need to have the nodule biopsied again after several months. 

If you have any further questions about your thyroid and plans for evaluation and treatment, please do not hesitate to ask Dr. Wolfe or his staff.