One Size Does Not Fit All When It Comes the Decision to Biopsy a Thyroid Nodule
Just like the refusal to do ultrasound in a screening or routine basis is essential to decrease unnecessary biopsies and surgery, refusal to allow a biopsy for very small nodules or ones listed below as ultrasound very low risk nodules can be followed without increased risk to the patient.
Clinical Indications for biopsy: rock hard nodule,fixed to neck structures,vocal cord paresis,suspicious lymph nodes,Family history of thyroid cancers, radiation exposure,+PET + sestamibi scan.
Ultrasound indications refusal of a biopsy. A review by expert second opinion BEFORE the Biopsy indicating there is no ultrasound findings to justify a biopsy now.
1.pure cyst Benign <1 % cancer risk
2.Spongiform nodules: very,very low suspicion <3 % risk
3.Mixed partially cystic/solid nodules with eccentric solid area: low suspicion 5-10% risk
4.Solid hyper and isoechoic nodules with regular margins low suspicion 5-10% risk
The smaller the nodule <1.5 cm the less the need for a biopsy.These can be followed instead of a biopsy unless they have clinical risk factors listed above.
Allowing ultrasounds and biopsy when not indicated are a possible risk for you from unnecessary surgery and even radiation therapy for small harmless nodules.
Learn to delay everything as there is no emergency to get a diagnosis of thyroid cancer, and get outside your network expert impartial opinions on then need for an ultrasound and a biopsy.
Richard Guttler MD,FACE,ECNU
Call Matt for details about review of you case before thyroid ultrasound,biopsy or surgery.
Images below of a nodules that DO Not Need a Thyroid Biopsy
3 spongiform nodules with very low risk of cancer <3% that can be followed without biopsy or surgery.