What to Expect During Your Thyroid Biopsy

A biopsy of your thyroid nodule or lymph node will be recommended for solid nodules > 1.5-2cm (not cysts), abnormal lymph nodes, and occasionally very suspicious appearing nodules that are 1cm in size. Current guidelines do not recommend thyroid biopsy of nodules < 1cm.

Dr. Goldfarb will perform an ultrasound-guided biopsy that same day in the office and a pathologist will look at the slides in real time to provide a preliminary diagnosis before the appointment is over.

This consists of a very small needle being inserted into your nodule or lymph node 2-3 times on ultrasound guidance. The entire process will take 5-10 seconds per biopsy pass. It will feel slightly uncomfortable and a little strange, but is not overtly painful.

Possible Biopsy Results

  • Nondiagnostic – there were not enough cells to make a diagnosis. Sometimes we will try to get more tissue during that visit. Other times, if the nodule does not look worrisome on ultrasound, we may choose monitoring with a possible rebiopsy at a later time.
  • Benign – no concerns for cancer. There is a small false negative rate meaning there is always a very small possibility there is cancer even though the biopsy is benign. This should only be of concern if the ultrasound is worrisome.
  • Indeterminate – there are no features that are overtly diagnostic of cancer but there are some microscopic characteristics that are somewhat abnormal as well. There is a spectrum of how concerning some of these features are. Depending on which features are seen and the ultrasound characteristics, we may take an extra biopsy specimen to send for molecular testing (see below)
  • Cancer (or likely cancer) – the cells under the microscope are diagnostic of cancer. Surgery is the treatment.

Molecular Testing for Thyroid Nodules

There are a few commercial tests available designed to help stratify the risk of cancer for patients that have indeterminate nodules. Some of these tests try and predict if a nodule is benign (and therefore you can avoid surgery), whereas others try to give a risk of cancer (and therefore if it is a high risk, surgery is usually recommended). None of the tests are perfect. Your doctor will discuss with you which one would be best in your individual case, and based on the results, come up with a personal risk assessment for cancer and a treatment plan.