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What is the thyroid gland?

• A butterfly-shaped endocrine gland
• Located in the lower part of the neck
• It produces thyroid hormones that regulate:
  • energy
  • body temperature
  • heart function
  • the brain, muscles, and other organs

What is a fine needle aspiration (FNA) biopsy?

• A diagnostic test that takes cells from a thyroid nodule or lymph node
• It is performed with a very thin, hollow needle, thinner than a blood sample
• The material sent for:
  • cytological examination
  • special tests, such as hormonal markers or gene mutations
• The purpose is to distinguish between benign and malignant, i.e. thyroid cancer

When is FNA indicated?

• When there is a nodule in the thyroid
• When the nodule is palpable or detected on ultrasound
• When there are suspicious ultrasound features (TI-RADS)
• When recommended by the attending physician
• When there are suspicious cervical lymph nodes

Preparation before the examination

• No fasting required
• No special preparation required
• Avoid wearing jewelry around the neck
• If you are taking anticoagulant or antiplatelet treatment, temporary discontinuation is required only after consultation with the treating physician
• Provide a doctor’s referral and previous tests, such as ultrasound or scintigraphy

How is the puncture performed?

Ultrasound examination

• Detailed thyroid ultrasound
• Evaluation of each nodule for the possibility of malignancy
• Use of modern techniques, such as perfusion studies and elastography
• Identification of the most suspicious point for material collection

Cervical mapping

• Ultrasound examination of the entire cervix
• Check for suspicious lymph nodes, i.e. possible metastasis
• Material collection from all suspicious points in the same session

Puncture procedure

• Skin antisepsis
• Optional local anesthesia, such as anesthetic cream in sensitive individuals or children
• Insertion of a thin needle under continuous ultrasound guidance
• Cell collection from different points of the nodule and from suspicious lymph nodes, if present
• In cystic nodules, fluid is aspirated
• Gentle pressure and small bandage
• Total duration: < 30 minutes

Is the examination painful?

• No
• The examination is painless and well tolerated
• Local anesthesia is not required in most cases
• Analytical cream is recommended for sensitive individuals or children approximately 1 hour before

ROSE – Rapid On-Site Evaluation

• Immediate cytological evaluation of the material (Rapid On-Site Evaluation)
• Sample adequacy check before leaving
• Minimizes non-diagnostic results
• Avoids repetition of the examination

Examinations that can be performed on the material

• Cytological examination
• Measurement hormones:
  • thyroglobulin
  • parathyroid hormone
  • calcitonin
• Checking for gene mutations, such as BRAF V600E
• These tests are useful for:
  • assessing cancer recurrence
  • locating lymph nodes
  • diagnosing parathyroid adenomas

Possible complications (extremely rare)

• Mild pain or tenderness for a few hours
• Small hematoma
• Very rarely, bleeding or infection may occur
• Dissemination has not been reported cancer cells

After biopsy

• Immediate return to daily activities
• Mild discomfort for 1–2 days
• Simple analgesics, such as Depon, are allowed
• Ice pack if needed
• Contact doctor if persistent pain occurs

Cytology results

• Available in 3 business days
• Possible results:
  • Benign → follow-up
  • Suspicious or malignant → further investigation/treatment
  • Non-diagnostic → repeat FNA, rare
• False negatives: 2–3%
• False positives: extremely rare

Factors that increase accuracy

• Physician experience
• Collection of material from all suspicious areas
• Use of modern ultrasound techniques
• Presence of a cytologist