Thyroid Biopsy

 

The basic diagnostic procedure used to assess thyroid nodules is a targeted fine-needle aspiration biopsy of the thyroid (FNA). In practice, this is usually referred to simply as a fine-needle aspiration biopsy because the needle is precisely directed into the thyroid nodule, most commonly under ultrasound guidance. At Tartaczna 2 Medical Centre in Gdańsk, we specialize in performing ultrasound-guided thyroid biopsies.

 

 

 

With ultrasound guidance, the doctor can accurately locate the thyroid lesion and obtain material for cytological examination with a high degree of precision. The collected cells are then evaluated by a pathologist, who examines them for possible malignant or inflammatory changes. Fine-needle aspiration biopsy of the thyroid is a safe outpatient procedure, which means that the patient does not need to remain in hospital after the examination.

 

• At Tartaczna 2 Medical Centre, thyroid biopsies are performed by Dr Artur Antolak, MD, PhD, a specialist pathologist who also evaluates the collected cytological material. Dr Antolak is a highly regarded specialist and currently serves as Head of the ALAB Pathology Laboratory at the Ministry of the Interior and Administration Hospital in Gdańsk. Thyroid biopsies are also performed by Dr Kamil Drucis, MD, PhD, a surgical oncologist.

 

When Should a Thyroid Biopsy Be Performed?

• A thyroid fine-needle aspiration biopsy is primarily recommended when ultrasound reveals thyroid nodules with suspicious features, such as microcalcifications, irregular margins or abnormal vascularity.
• Biopsy may also be recommended for thyroid nodules that are growing rapidly, as rapid growth may raise suspicion of malignancy.
• Another indication for thyroid FNA is a positive family history, particularly in patients with a genetic predisposition to thyroid cancer.
• A thyroid biopsy may also be performed for diagnostic purposes when inflammatory thyroid disease is suspected, including conditions such as Hashimoto’s thyroiditis or Riedel’s thyroiditis.

 

Fine-needle aspiration biopsy can help confirm or exclude thyroid cancer, which is essential for planning appropriate treatment at an early stage.

 

 

How Is a Thyroid Fine-Needle Aspiration Biopsy Performed?

The procedure is performed with the patient lying down and the head slightly tilted backwards to provide easy access to the thyroid gland. Using ultrasound guidance, the doctor precisely identifies the area from which the sample should be obtained. A fine needle is then carefully inserted into the thyroid nodule and cytological material is collected.

The procedure usually takes only a few minutes. Due to the small diameter of the needle and precise ultrasound guidance, most patients experience only minimal discomfort. Once the sample has been collected, a small dressing is placed over the puncture site.

 

 

How to Prepare for a Thyroid Biopsy

A fine-needle aspiration biopsy of the thyroid does not require complicated preparation. Before the procedure, the patient should remove jewellery from the neck area and inform the doctor about all medications being taken. This is particularly important for patients receiving anticoagulant or antiplatelet treatment.

Patients often ask whether anesthesia is necessary. Local anesthesia is not routinely used for thyroid FNA because the procedure usually causes only mild discomfort comparable to a standard injection or blood draw. In many cases, the injection of local anesthetic itself may be more uncomfortable than the biopsy. No other special preparation is usually required, which makes the procedure easy to schedule and perform.

 

Thyroid Biopsy Results and Pathological Examination

The collected material is examined carefully under a microscope. Because fine-needle aspiration collects cells rather than a tissue fragment, the result is a cytological examination. A specialist pathologist assesses the cellular structure and determines whether the lesion appears benign, malignant or inflammatory. Results are usually available after the laboratory processing period and are essential in determining further treatment.

If the result is inconclusive or suggests malignant cells, further diagnostic verification may be required. In selected cases, definitive diagnosis may only be possible after surgical removal of the lesion and full histopathological examination.

Despite being minimally invasive, thyroid FNA is a highly useful diagnostic tool that helps physicians make appropriate decisions regarding further management.

 

 

Thyroid Nodule Biopsy Results

 

During a fine-needle aspiration biopsy, the doctor collects cells from the thyroid lesion for cytological assessment (PATHOLOGY). The examination helps determine the nature of the lesion and classify it according to the Bethesda System for Reporting Thyroid Cytopathology. The classification takes its name from Bethesda in the United States, where the system was developed.

 

 

Bethesda Classification of Thyroid Biopsy Results

 

• Category I – nondiagnostic or unsatisfactory material. The biopsy should be repeated. The estimated risk of malignancy in this category is approximately 2–4%, and such results account for approximately 5–11% of thyroid biopsies.
• Category II – benign lesion. The estimated risk of malignancy is approximately 0–3%. This is the most common result and accounts for approximately 55–74% of biopsies. Further observation is usually recommended, with repeat biopsy considered if the thyroid nodule increases in size.
  If the cytological result is benign but the ultrasound appearance remains suspicious or the nodule is large, repeat biopsy may be considered.
• Category III – atypia of undetermined significance or a follicular lesion of undetermined significance. The estimated risk of malignancy is approximately 5–15%. Follow-up thyroid ultrasound after 4–6 months and, where appropriate, repeat biopsy may be recommended.
• Category IV – suspicious for follicular neoplasm. Follicular thyroid cancer and benign follicular lesions are difficult to distinguish by cytology alone. The estimated risk of malignancy is approximately 15–30%.
• Category V – cytological findings suspicious for thyroid cancer. The estimated risk of malignancy is approximately 60–70%.
• Category VI – malignant cytological result with a very high probability of thyroid cancer. The estimated risk of malignancy is approximately 97–99%.

 

Lesions classified as Bethesda V or VI generally require surgical treatment. Bethesda IV lesions may require a more individualized approach. Genetic or molecular testing of the thyroid nodule may sometimes provide additional information, although it is not performed routinely in every patient. Consultation with an experienced surgeon is recommended to determine whether surgery is indicated.

Because benign follicular adenomas and follicular thyroid carcinomas cannot always be distinguished by cytological examination alone, a definitive diagnosis may only be possible after surgical removal of the lesion and complete histopathological examination.

 

 

Prognosis in Thyroid Cancer

 

The prognosis for most thyroid cancers is generally very good. The widespread use of thyroid ultrasound makes it possible to detect small tumors while they are still confined to the thyroid gland, increasing the likelihood of successful treatment. Papillary thyroid cancer, which has one of the most favorable prognoses, is associated with very high long-term survival rates, particularly when diagnosed at an early stage.

 

 

 

Is a Thyroid Biopsy Painful?

One of the most common questions patients ask before the procedure is whether a thyroid biopsy is painful. Because a very fine needle is used and the puncture is performed precisely under ultrasound guidance, fine-needle aspiration biopsy usually causes only mild discomfort. Most patients describe the sensation as similar to a vaccination, injection or blood draw.

Anesthesia is usually unnecessary. In selected patients who experience significant anxiety or discomfort, topical anesthesia of the skin may be considered. A small bruise or minor hematoma may occasionally appear at the puncture site after the procedure and usually resolves spontaneously within a few days.

 

 

Contraindications to Thyroid Biopsy

 

Contraindications may include severe bleeding disorders and active inflammation or infection in the neck area. Patients taking anticoagulant or antiplatelet medications should discuss their treatment with the doctor before the biopsy and should not discontinue such medication without medical advice.

 

Book a Thyroid Biopsy at Tartaczna 2 Medical Centre in Gdańsk

 

Early diagnosis of suspicious thyroid nodules with fine-needle aspiration biopsy (FNA) may help detect thyroid cancer at an early stage, when treatment is often highly effective.

 

At Tartaczna 2 Medical Centre in Gdańsk, we provide comprehensive thyroid biopsy diagnostics performed by experienced specialists using high-quality ultrasound equipment. We invite you to book a consultation and thyroid biopsy with Dr Artur Antolak, MD, PhD, or Dr Kamil Drucis, MD, PhD. If thyroid cancer is diagnosed, an oncology consultation can also be arranged with our oncologist, Dr Magdalena Korożan.

 

Please note that the waiting time for the pathological examination result is approximately 30 days.