- Douglas S Ross, MD
Douglas S Ross, MD
- Section Editor — Thyroid Disease
- Professor of Medicine
- Harvard Medical School
Thyroid nodules come to clinical attention when noted by the patient, or as an incidental finding during routine physical examination or a radiologic procedure, such as carotid ultrasonography or neck computed tomography (CT). Their clinical importance is primarily related to the need to exclude thyroid cancer, which is present in 4 to 6.5 percent of thyroid nodules overall but up to 15 percent of thyroid nodules in the older patient population. If a serum thyroid-stimulating hormone (TSH) is normal, the next step in the evaluation of a thyroid nodule is a palpation or ultrasound-guided fine-needle aspiration (FNA) biopsy.
This topic will review the techniques, utility, limitations, and complications of percutaneous thyroid biopsies. Ultrasound-guided thyroid biopsy, an atlas of cytopathologic findings, and overview of the diagnosis and treatment of thyroid nodules are discussed separately. (See "Ultrasound-guided thyroid biopsy" and "Atlas of thyroid cytopathology" and "Diagnostic approach to and treatment of thyroid nodules".)
The two most common methods used to obtain tissue from thyroid nodules are fine-needle aspiration (FNA), using a syringe, and fine-needle capillary sampling (FNC), which is done without aspiration. Biopsy can be guided by palpation only or by ultrasound.
Other techniques include large-needle aspiration biopsy and cutting-needle biopsy. The latter has shown to be particularly useful for repetitive nondiagnostic FNAs. (See 'Other techniques' below.)
Fine-needle aspiration biopsy — FNA is a simple and safe office procedure in which tissue samples are obtained for cytologic examination. FNA is performed with or without local lidocaine anesthesia , by repetitively moving a 23- to 27-gauge (most commonly 25- or 27-gauge) needle through the nodule. The needle is attached to a 10 mL syringe that may be contained in a holder designed to facilitate the application of constant or intermittent suction. The aspirated material is smeared directly on slides, fixed, and stained, or collected in a liquid preservative from which thin-layer preparations are made. (See 'Procedure' below.)
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- Fine-needle aspiration biopsy
- Fine-needle capillary sampling
- FNA versus FNC
- Ultrasound guidance
- Other techniques
- Choice of technique
- SENSITIVITY AND SPECIFICITY
- DIAGNOSTIC CATEGORIES
- Atypia of undetermined significance or follicular lesion of undetermined significance
- Follicular neoplasm (microfollicular)
- - Hürthle-cell tumors
- Suspicious for malignancy
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS