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What Do The Following Ultrasound Reports Indicate?
Question: I am a returning patient to this site (I have been monitored for a multi-nodal thyroid). Two weeks ago, I underwent an US and a 2nd biopsy on a nodule in R thyroid, inferior lobe (9mm before draining, 7mm after draining). The first biopsy was taken in 2011 and showed complex cyst, 2.5cm containing: fluid, non-cancerous cells and an inconclusive diagnosis on a 3rd portion of the nodule due to too few cells. After draining the cystic fluid, the remaining nodule was 6mm in size.
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"
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"
Brief Answer:
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
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
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello again Dr XXXXXXX
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.
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.
Brief Answer:
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.
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.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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