The thyroid gland is a butterfly-shaped gland in the front of the neck. It consists of two lobes connected by a narrow band of tissue called the isthmus. The gland makes thyroid hormones that are required for several body functions. Sometimes the thyroid gland can develop abnormal lumps, nodes, or the entire gland may be enlarged. A thyroid fine-needle aspiration biopsy or fine-needle aspiration cytology is a minimally invasive procedure. A small sample of tissue is obtained from the thyroid gland using a hollow needle. The sample is analyzed under the microscope using the small, hollow needle and then sent to the lab for analysis.
Fine needle aspiration is typically an outpatient procedure. The cost of fine-needle aspiration can vary between 400 USD to 1600 USD or more, depending on the hospital and surgeon. The cost may go up if ultrasound guidance is used. One may check with their insurance company to check if the plan covers the costs.
Why is fine needle aspiration of thyroid done?
The thyroid gland can develop abnormal lumps, nodules, cysts or the entire gland may be enlarged. These abnormalities may be noticed by the patient or by the doctor during a routine examination. The test can help determine whether the growth is hyperactive or hypoactive and whether it is cancerous, as well as helps the doctor chalk out an appropriate treatment. Not all thyroid nodules need fine needle aspiration biopsy. The doctor may recommend computed tomography (CT) scan or an ultrasound of the neck first before proceeding to biopsy. Blood tests of thyroid levels would also be done.
The cause of many thyroid nodules may not always be known. They are more common in women than in men. Exposure to radiation due to occupation, cancer treatment of the chest, head, or neck, and/or genetics can increase the risk of thyroid cancer. Only a small percentage of thyroid nodules are found to be cancerous. Early diagnosis and treatment of thyroid cancer have a high cure rate.
What are the risks of thyroid fine needle aspiration biopsy?
Fine needle aspiration biopsy is a safe procedure with an extremely low risk of complications. Some possible risks include:
- Bleeding at the biopsy site
- Damage to the structures around the thyroid, but this is rare because most doctors would use ultrasound guidance.
- A repeat biopsy may be needed because sometimes, fine needle aspiration may not show cancerous cells.
How is fine needle aspiration performed?
There is little preparation needed before the procedure. The doctor may advise discontinuing certain medications like blood thinners. Patients can go home the same day after the procedure. It is performed under local anesthesia. Most patients may not need local anesthesia since the needle is so small and there is very little discomfort. Children may need a mild sedative to help them relax.
The procedure may be done with the help of ultrasound guidance. To locate the exact site of biopsy and to avoid damage to surrounding structures. A gel-like substance will be applied to the neck, where the ultrasound detector will be used. The doctor disinfects the skin and inserts a thin, fine needle into the thyroid gland. This may cause a little pain, which is similar to getting a shot. The doctor slowly advances the needle into the nodule, moving it back and forth several times to collect a sufficient number of cells. The needle is attached to a syringe to withdraw the cells. This procedure may be repeated a few times to obtain different samples from different parts of the nodule.
After the procedure:
After the procedure, the collected samples are sent to the laboratory to be studied by a pathologist. A small dressing may be applied, which can be removed after a few hours. Most patients can resume their normal activities right after the procedure. There may be swelling, bruising, and soreness around the biopsy site, but this usually resolves in 2-3 days. Over the counter painkillers can help with the pain. It may take a few days (up to a week) to get the test results back from the pathology lab. Based on the results, the doctor would advise a treatment plan if treatment is required.
American Thyroid Association. Fine Needle Aspiration Biopsy of Thyroid Nodules. https://www.thyroid.org/fna-thyroid-nodules/
Liebert MA. Thyroid Fine Needle Aspiration (FNA) and Cytology. Medscape, Thyroid. 2003;13(1). https://www.medscape.com/viewarticle/452663
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