5 Things to Know About a Thyroid Biopsy

You just saw your doctor and they told you that your thyroid nodule needs a biopsy. What are 5 things you should know about a thyroid biopsy?

       1.  Not all thyroid nodules need a biopsy.

If you have a thyroid nodule that is not suspicious (usually a cystic thyroid nodule), the risk of cancer is very low. Usually, a biopsy is not required. Also, nodules that are very small usually don't require a biopsy because the risk of them being aggressive is so low.

2. The need for a biopsy/FNA is determined by the ultrasound.

When you have your thyroid ultrasound, your doctor will determine the need for a biopsy based on an ultrasound. Ultrasound is the best tool for thyroid nodule determination, even better than a PET scan or a CT scan.

3. Fine Needle Aspiration (FNA) is better than open biopsies or core needle biopsies.

There are lots of ways to do a biopsy, so why is FNA the best? FNA is the best because the risks of the procedure are exceedingly low, even in patients who are taking blood thinners. Other procedures, like a core needle biopsy, could injure structures that are near the thyroid, such as the carotid artery or the recurrent laryngeal nerve. Even worse, open biopsies in the operating room could cause scar tissue that makes it challenging to eventually do surgery. While there is a time and a place for each of those types of biopsy, it is up to your doctor to explain to you why you need them, because FNA is the standard of care. And, the best part is that FNA recovery is very quick and relatively painless for most patients, and you can usually return to normal activities the same day.

4. Not all biopsies will give you a definitive result, but that doesn't mean you need another biopsy.

Some thyroid cancers have cerlls that look very normal, even while the cancer is spreading. For that reason, some biopsies don't give a final answer. Sometimes we can use genetic testing such as AFIRMA or ThyroSeq to help us know the relative probability that a nodule is a cancer... but they aren't perfect. Each of those tests only provides a probability, and it is up to you and your doctor to determine what is right for you (surgery vs no surgery) based on those results.

5. Rapid On-Site Evaluation (ROSE) provides the most accurate results and is less likely to require a repeat biopsy.

When you have a fine needle aspiration (FNA), your doctor will usually just send over all of the specimen over to a pathologist so that they can look at it. BUT, the best way to do it (the most accurate and the fastest), is to have the cytopathologist in the room at the same time as the biopsy/FNA. Why? Because they can look at it in real time, confirm if they needle more biopsy samples right then and there, and even give the patient and doctor a probability of whether or not it's cancer. Because of this, accuracy increases significantly.

If you need a thyroid nodule biopsy, ask for an FNA, and ideally make sure that you do it with a cytopathologist on-site. The Russell Center is one of the best places to have this done quickly, so please give us a call.