What Do The Following Ultrasound Reports Indicate?
US two weeks ago showed the nodule had increase in 4 years to 9mm, although 2mm was fluid. Endo did not like look of things, so proceeded to take FNA, 3 samples. The results of this second biopsy are as follows: "The smear shows scant background granular proteinaceous material and recent hermorrhage. No intact groups of bland folliculr epithelial cells are identified. Risk of Malignancy: 1 - 11.5% with an average of less than 5% based on a review of literature".
My endocrinologist says he cannot recommend what to do; and has referred me to a thyroid surgeon for further discussion. I would appreciate any advice, direction, etc on this, as I do not wish to jeopardize my health, and yet at the same time, I do not want to undergo unnecessary surgery.
Apologies, I should have added:
"DIAGNOSTIC CATEGORY: NON-DIAGNOSTIC, Sparse or degenerated cells"
Surgical excsion biospy and Frozen section may be appropriate
Detailed Answer:
Good day,
Welcome back. Noted your concern. The recent FNA suggests that, there was not enough cells in the FNA material. There are 2 options now.
a) Repeat an ultrasond and FNAC in 3-6 months.
b) Second option is to go for an excision biospy.
I would prefer the second option in your case, as the chances of getting enough material in a repeat FNA is poor due to fluid and blood in the nodule.
Excision biopsy involves surgery and the surgen can take out enough material and subject for a rapid histopathology examination ( Frozen section) in the operation theatre itself and based on this, immeidetly a decicision can be taken whether to go for a complete removal of thyroid or not. In your case, that seems to be a good option. However, a surgeon will have to examine you and review the scans before a final decision can be made.
Regards
Binu
Endo also suggested a 3rd biopsy was not going to be a good option, so concurs with you completely.
Is there any particular reason why I'm growing something that doesn't show 'enough' cells? As layperson, it's slightly confusing--so, is it because the FNA isn't sensitive enough to capture cells that are there; or, does the pathologist need a certain number of cells to make an identification?
Sorry about the ignorant question--it's just that I know the endo was really 'digging into the nodule' and got 2 very good samples; yet there are too few cells.
Small needle may not be able to get sufficient material.
Detailed Answer:
Yes, the pathologist need sufficient cells for diagnosis. FNA is done to rule out cancer.
FNA is done using a small needle and many a times, enough material can not be obtained . The failure rate of FNA is more , when there is cyst/fluid or blood in the nodule.
Now a days, endocrinologists combine FNA with molecular cancer detection tools which may be yield better results.Please discuss this option with your endocriologist.