Understanding Fine Needle Aspiration Biopsy
Fine needle aspiration biopsy, also known as fine FNA, is a diagnostic procedure used to evaluate the growth or nodule in the thyroid gland. It involves using a very thin needle to extract cells from a nodule for microscopic histological examination.
The primary purpose of an FNA is to collect cells from the suspicious nodular growth of the thyroid gland and determine whether it is non-cancerous (benign) or cancerous (malignant). Ultrasound-guided needle aspiration is also done to aspirate large thyroid cysts and cystic nodules.
Suitable Patients for Fine Needle Aspiration Biopsy
Here are the factors that might determine your suitability for this procedure:
- Presence of a Lump or Mass: You are a candidate for FNA if you have a palpable lump or mass that needs to be diagnosed. This includes lumps in the thyroid, breast, lymph nodes, and other accessible tissues.
- Need for Minimally Invasive Procedures: If your medical condition or the location of the mass allows for a minimally invasive approach, FNA may be appropriate.
- Age and General Health: While there are no specific age restrictions, your overall health and the ability to tolerate minor procedures without significant risk are considered.
Discussing your medical history with your Endocrinologist is crucial to determining if FNA is the best diagnostic tool for your needs.
Benefits of a Fine Needle Aspiration Biopsy
Cellular data collected from an FNA helps Endocrinologists understand whether the lump is non-cancerous (benign) or cancerous (malignant).
Benign
Malignant
Photo credit: National Center for Biotechnology Information
- Good Accuracy: An FNA of thyroid nodule is precise in diagnosing thyroid cancer. When cells are extracted directly from the lump, a pathologist examines them under a microscope to assess if the histological features suggest underlying thyroid cancer. This accuracy is crucial for planning the appropriate course of treatment without unnecessary delay.
- Minimally Invasive: This means there is minimal disruption to the body tissues, which significantly reduces the physical trauma typically associated with surgical biopsies. Patients generally experience mild discomfort during and after the procedure.
- Lower Risk of Complications: FNA is a safe procedure. Some patients may experience mild bruising and poking pain during biopsy. Local anaesthetic spray or local injection is given to minimise the pain of needle poking.
What to Expect Before, During, and After a Fine Needle
Aspiration Biopsy
Before the procedure
No special preparations like fasting or medication adjustments are needed unless specifically instructed by your doctor.
- Positioning: The patient usually lies down, with the neck extended to better expose the thyroid area.
- Anaesthesia Application: A local anaesthetic is often applied to numb the area. However, the procedure can also be performed without anaesthesia because the needle used is very thin.
- Needle Insertion: The doctor gently inserts a fine, hollow needle directly into the nodule.
- Ultrasound Guidance: Ultrasound is always used to precisely locate the nodule and guide the needle to the correct spot.
- Aspiration: A needle attached to a syringe is used to aspirate (draw out) cells and fluid from the nodule.
- Multiple Passes: Several passes may be made with the needle to collect enough cells for analysis.
After undergoing an FNA, you can usually resume normal activities immediately and may experience the following:
- Swelling for a few days following the procedure: If swelling occurs, apply a cold compress (for instance, an ice pack or a cool washcloth) on the area for 10 minutes to reduce the swelling. It’s important to follow this procedure to ensure comfort and reduce inflammation.
- Possible Minor Complications: While serious complications are rare, minor bleeding under the skin at the biopsy site can result in a small bruise.
When Will the Test Results be Available
The biopsy result is available in 3 to 5 working days, but your Harmony Clinic team will usually inform you when the results are available, and Dr Vikram will explain the pathology report in detail.
If you have lumps or masses in the body, book an appointment with Dr Vikram Sonawane, who is the Medical Director of Harmony Thyroid Endocrinology and Diabetes Centre and an experienced Endocrinologist. It is important for you to get your lumps or masses evaluated by an Endocrinologist to determine whether they are cancerous or not.
With Dr Vikram’s expertise in FNA, he can provide you with an accurate diagnosis. He was instrumental in establishing the Thyroid & Fine Needle Aspiration and Cytology (FNAC) Clinic at Khoo Teck Puat Hospital (KTPH). Moreover, he conferred the Ministry of Health’s HMDP sponsorship in 2015 for a fellowship to train in Fine Needle Aspiration Biopsy of the thyroid, Nodular Thyroid Disease, and Clinical Thyroidology at the prestigious Mayo Clinic, Rochester, Minnesota, USA.
References:
- Mayo Clinic. Needle biopsy – Mayo Clinic. Mayoclinic.org. Published 2018. https://www.mayoclinic.org/tests-procedures/needle-biopsy/about/pac-20394749
- Thyroid Fine Needle Aspiration Biopsy. www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/thyroid-fine-needle-aspiration-biopsy
- Jasim S, Dean DS, Gharib H. Fine-Needle Aspiration of the Thyroid Gland. [Updated 2023 Mar 23]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK285544/