What is a Thyroid Biopsy? How is a thyroid biopsy performed?
You may have thyroid problems or have people around you with this conditions. In some cases, your doctor or radiologist may decide to order or perform a thyroid biopsy as a complementary test and use the results for diagnosis and treatment of thyroid nodule.
Occasionally, just knowing the requirement for biopsy is anxious for patients and they may ask numerous questions including: what is the biopsy for? Is it painful? It needs anesthesia like a surgery? Why does the doctor consider it necessary? They even go further and think that it is requested because the doctor believe that they have cancer. In the following, we answer all of these and other questions so that if you need a thyroid biopsy, you would no longer have to worry about it.
What is Fine Needle Aspiration Biopsy of the Thyroid?
Simply put, thyroid biopsy is extraction of a small piece of thyroid gland or thyroid nodules by a radiologist for pathological examination in pathology laboratory to obtain the necessary information for disease differentiation.
History of Thyroid Biopsy
Before the invention of modern biopsy techniques such as Fine Needle Aspiration (FNA) and Core Needle Biopsy, physicians sometimes had to remove a large amount of thyroid gland during surgery to make sure the patient was not at risk of malignancy. In some cases the complications of this method was required the patient to take medications and had some adverse effects. However, thanks to progress in the field, most of these complications are circumvented and now there is no need for anesthesia or surgery for biopsy.
What is the reason for Thyroid Biopsy?
Thyroid nodules are very common masses in the thyroid gland (The thyroid gland is located in front of the neck and is shaped like a butterfly). Although these masses can cause problems for the patient, often they are not cancerous. In some cases, the thyroid gland may start to grow in size. Called goiter, this condition may need treatment, but not necessarily, and in most cases this does not mean cancer. Before the biopsy, doctors may order blood tests and then imaging study for patient and based on the results of these examinations the decision for thyroid biopsy is made.
What can the results and interpretation of the thyroid biopsy say?
Using simple terms, in this section we explain some conditions that may be mentioned in thyroid biopsy report.
Interpretation of thyroid biopsy results:
If the biopsy results indicate a problem, it can be one of the following conditions:
- Cysts or nodules which are fluid-filled masses that can cause pain in throats or make swallowing difficult for the patient. Although these cysts are rarely cancerous, they need treatment.
- Graves’ disease which is a kind of hyperthyroidism with thyroid enlargement and too much hormone secretion.
- Hashimoto’s disease which is a thyroid disease in which the immune cells invade the thyroid gland. This attack often leads to thyroid gland swelling and underactivity or hypothyroidism.
- Infection, in which actually a virus causes pain and swelling in the thyroid gland.
- Large nodules or goiter that cause problems for the patient because of their size, including difficulties in breathing and swallowing.
- Toxic nodules or goiter that are almost never cancerous and cause the thyroid gland overproduction.
- And finally cancer that can occur in ten percent of the population.
(Therefore, as all radiologists recommend, when a thyroid biopsy is ordered for you don’t worry, take it easy and prioritize it in thyroid biopsy centers.)
When do you need a thyroid biopsy?
Although thyroid biopsy results can indicate goiter or thyroid nodules, it is not always necessary for thyroid disease diagnosis; for example, in Graves’ disease, blood tests and imaging studies are enough to find evidence for disease differentiation.
Sometimes the radiologist may find it necessary to do more examinations for any thyroid nodule with diameter larger than one centimeter, especially in cases of solid, firm and calcified nodules with indistinct borders in imaging studies.
Also, if the patient suffers from intense pain in his/her thyroid and the gland is growing rapidly, the radiologist may want to perform thyroid biopsy despite the lack of thyroid nodule.
How a thyroid biopsy is performed?
This section is for those who want to know whether a thyroid biopsy is performed surgically in the hospital, what the patients feel about it, and whether they experience complications after the biopsy or not.
Thyroid biopsy can be performed in two general forms: invasive and minimally invasive. The invasive procedure include the traditional thyroid surgery with removal of a small specimen of the gland; so, it needs needle and incision. But minimally invasive procedure is something different.
If you’re still worried and looking for answers, check out this movie for sure:
Thyroid biopsy Procedures
Fine Needle Aspiration (FNA)
In this minimally invasive biopsy procedure, a fine and delicate needle is being used for the biopsy. The pain produced by this form of biopsy is similar to that of a pinch (low pain) so that no anesthesia is required. Sometimes the radiologist just use a local anesthesia for this procedure.
In FNA thyroid biopsy, the radiologist uses ultrasound as a guide to identify proper location for needle placement and biopsy. Then a needle is being used for sampling. In this stage of procedure you may have a slight feeling of the needle. Occasionally, the radiologist may consider it necessary to perform the sampling and biopsy several times.
The radiologist may also take samples of the patient’s lymph nodes located near the thyroid gland.
This procedure will take about half an hour and the patient doesn’t need to fast before or after it.
Preparations for FNA thyroid biopsy
Like any other tests, for thyroid biopsy it is advisable to keep your doctor informed of medications you are taking. This may be necessary to discontinue or take lower doses of anticoagulants (blood thinners) including warfarin, dipyridamole, prasugrel, and similar medications before or after the biopsy. Notify your doctor and radiologist about these medications, but never discontinue or take lower doses of medications without consulting your doctor (It is very important).
The experience of biopsy by other patients is provided in this website. By reviewing their experiences, you can perform the biopsy with more confidence. So, we recommend you to have a look at them.
Core Needle Biopsy
This form of biopsy is similar to the FNA, except that the needle is slightly larger. This ultrasound-guided procedure requires no skin incision and the objective is taking a cellular sample by removing a small specimen of the nodule for pathological examination. Because this procedure provides a piece of target nodule tissue, the pathological examination result is often sufficient to diagnose the disease. In other words, if your doctor can’t make a reliable diagnosis based on FNA results, Core Needle Biopsy will be an acceptable alternative.
Comparison of FNA and Core Needle Biopsy
With high experience in performing different thyroid biopsy procedures, the Tirad Institute of Imaging is regarded as a major center for Core Needle Biopsy referral. Although the rate of complications for this procedure is as low as FNA, the requirement for using a special needles makes it more expensive than FNA.
Surgical biopsy
Since surgical biopsies, like other surgeries, require anesthesia in monitored and hospital conditions and need longer recovery periods, they are mostly abandoned. In these thyroid biopsy procedures up to half of the thyroid gland may be surgically removed and sent for pathological examinations.
What happens after a thyroid biopsy?
The results of the biopsy test may be delivered to you in a few days, but occasionally it may take up to two weeks. The management plan of the condition will depend on your test results; your doctor may ask you to be followed periodically and regularly to make sure your disease progression and treatment process is under control. If thyroid biopsy results indicate cancer, surgery may be necessary, but don’t worry because most thyroid cancers are treatable.In other cases, your doctor may need to manage your thyroid condition with different treatments.
finally
At the front line of innovative and minimally invasive technologies for treatment of cancerous and non-cancerous thyroid conditions, we have been able to achieve significant progress in the field at the Thirad Imaging and Ultrasound Institute, as the first specialized center for the treatment of thyroid diseases in collaboration with professors and specialists graduated from European countries. We promise easy, outpatient and totally tolerable treatments at our institute.
To find out more about these treatments, you can review the related videos in the gallery section of this website and consult our institute specialists for these techniques.