Dr.Guttler’s comments about American Thyroid Association patient information on Thyroid fine needle biopsy of thyroid nodules. This is found on their website, www thyroid.org.
I list what was not on this watered down version on what you should now about thyroid ultrasound and FNA.
Thyroid No Surgery 101: Part 2: Thyroid Ultrasound and Fine Needle Biopsy.The Two Most Dangerous Procedures Without Expert consultation.
Thyroid Fine Needle Biopsy FNA: They call this a simple procedure. Any physician can stick needles in the thyroid by palpation or US guided method. Most are done by radiologists with only limited understanding of thyroid disease, except they know where the thyroid is located to put in the needles.Most endocrinologists aren’t certified in FNA and are too busy treating diabetics to get certified to be able to do their own FNA. ECNU certified endocrinologists are listed on the aace.com website.
What about the procedure?
- No one should be doing thyroid FNA if they aren’t ready to collect molecular markers during the first biopsy.
- If the biopsy is Benign class II they can discard to small vial containing the DNA mutations and microRNA classifiers.
- If it is a cyst they need to collect Markers thyroglobulin TG and Parathyroid hormone PTH.
- If it is upper pole nodule possible Medullary cancer they need serum and needle washout for calcitonin and TG.
- If there are enlarged suspicious lymph node they need to sample the node first for cytology and TG in the needle washout.
- Rapid assessment of the first needle stick by DifQuik can determine the type of needle and technique needed for a successful biopsy.
- Bloody sample = smaller needle and rapid withdrawal.
- Dry tap= larger needles and suction.
- Bad technique and failure to check if you have a good first sample leads to 20% inadequate and a repeat FNA..
- Failure to collect markers during the first FNA if needed results in repeat FNA.
- The surgery in patients with indeterminate biopsy result can be avoided in patients with benign nodules if the molecular markers were done BEFORE rush to surgery.
- Incorrect information given to the patient that most nodules that are indeterminate are “pre-cancer” and will cause troubles later and should be removed.
- Call for second opinion at 310-393-8860 or [email protected]