Thyroid Nodule Biopsies 101: Smaller Needle and No Suction is Better to Reduce Inadequate Results.
Moss WJ et al
Thyroid 28(7)2018 p.857
Dr. Guttler’s comments on this article.
- 4500 nodules reviewed.
- No suction technique was superior to suction method.
Just the needle only with no suction from the syringe or pistol allow for the best results.
Suction pistol is rarely needed except for hard nodules.
- There also was a trend toward favoring smaller gauge needles.
Smaller needles allow most follicles to enter easily with out suction.
- Less pain and complications with smaller needle makes it of no value to use bigger needles.
- I have been using #25 and 27 skinny needles for years and only use suction when there is thick material that does not enter the smaller needles easily. Suction is another tool to obtain material in some cases.
- Also many operators using large needle or suction fail to use the three ways to get results with bloody samples. Snap and pop methods.
- Take the sample from the end of the needle and snap it on the slide. The first material in a bloody sample is rich in cell s whereas the tip of the needle is the diluted end with no cells.
- If the blood get into the hub of the syringe, pop it on the slide and discard what is in the needle as it is worthless.
- Finally many operators not do on-site adequacy. First slide stained with a rapid stain can see if the technique is adequate to get the needed cells for diagnosis. If the cells are insufficient adjust the technique on the fly.
- #25-#27 needles can be used without local in my practice.
Endocrinologist doing on-site adequacy with a rapid stain with first slide.
Come to see me for a nodule biopsy or second opinion on one you had. Indeterminate results should not be a ticket to surgery. I will add molecular markers and classifier to the repeat biopsy protocol.
Richard Guttler MD,FACE ECNU