Puncture of the thyroid gland is a simple procedure that consists of puncturing nodules in this organ in order to assess the risk of its malignancy. This is a fundamental test in thyroid diagnosis as it provides a lot of information with little or no risk of complications.
How the procedure works
Puncture of the thyroid gland is usually done in an "eco-oriented" way - guide the needle with ultrasound to make sure that the organ is punctured only in the right place.
If you have thyroid problems, you need medical advice. When should this procedure be carried out? Each case will be studied individually. The main tests to perform are:
- ultrasound;
- hormonal analysis;
- clinical examination.
If, according to these data, there are suspicions that the node may be malignant, then a puncture of the thyroid gland is performed. The most important factors in determining the suspicion of a nodule and, therefore, taking a puncture, are the size and appearanceorgan on ultrasound.
When a puncture is needed
In general, nodules smaller than ten millimeters will not be punctured unless risk factors (e.g., "irregular borders" or microcalcifications) are seen on ultrasound.
Thyroid puncture reviews report that large nodules (larger than 15-20 mm) should almost always be punctured unless ultrasound shows they are purely cysts (fluid sacs). In this case, a puncture may be done to reduce the size of the nodule. But there will be very little analysis, since only solid material, not liquid, can be analyzed.
Be aware that thyroid nodules are very common problems, the vast majority of them being benign. Therefore, the mission of the endocrinologist is, on the one hand, to detect suspicious nodules in order to puncture them, and on the other hand, to avoid puncture of nodal areas with a very low probability of being malignant.
Preparing for the procedure
Puncture of the thyroid gland under ultrasound control requires careful preparation. A preliminary analysis is necessary, mainly for two reasons. First study thyroid hormones, coagulation and make sure there is no risk of bleeding. The patient must be accompanied. Some sensitive people may experience dizziness immediately after the piercing, although symptoms usually disappear within a short time.
Medications that may interfere
It is very important to tell your doctor about all medicines you take regularly and if you are allergic to medicines or other foods.
Need to stop taking anticoagulants ("drugs to thin the blood") such as:
- "Acenocoumarol";
- "Warfarin";
- "Dabigatran";
- "Rivaroxaban";
- "Apixaban".
You should avoid aspirin, ibuprofen and other anti-inflammatory drugs for a week before the test. No need to take any additional medications.
Food
There is no special diet required, although some centers recommend not eating for about eight hours before the test. As a rule, it will be enough not to eat breakfast or drink anything before having a thyroid puncture.
Clothes
It is advisable to wear wide-necked clothing or one that can be easily opened (such as a button-down shirt) to free the thyroid area. Avoid wearing necklaces or other jewelry around your neck.
Pregnancy and lactation
Puncture of the thyroid gland is not contraindicated in pregnancy or breastfeeding, but you will need to inform he alth care providers about pregnancy or suspected pregnancy. Some hormones change naturally during these stages, this can affect the analytics.
How is the procedure?
If the nodule is alive, ultrasound-guided puncture may not be possible. In some cases, chest nodules may be checked by CT-guided puncture, or exploratory surgery may be required.
Puncture of the thyroid gland under the supervision of specialists lasts approximately 15-20 minutes. Getting the biopsy itself is very fast, the rest of the time is to prepare the material and the area to be biopsied.
Puncture of the thyroid nodule is performed on the patient lying on his back in a position that leaves the thyroid gland open. Sometimes a pillow is placed under the shoulders to help with neck hyperextension. After the patient has assumed a horizontal position, a local antiseptic will be injected and the doctor will find the node to be pierced by ultrasound.
The puncture is performed with a very thin needle, which must reach the thyroid gland (usually thinner than the thyroid gland). With the needle in the knot, gentle suction movements will be made to ensure that the tissue is removed, then the needle will also be removed. During this part of the procedure, the doctor warns the patient to try not to cough, swallow, or speak: when the thyroid gland moves, it will be more difficult to diagnose.
Two to six punctures are usually required, depending on the quality of the sample obtained. This way, the full size of the nodule is covered, and a more accurate diagnosis is more likely.
If it is a cystic nodule, it can be emptied with a syringe toreduce size and relieve discomfort. After the puncture is completed, you will be asked to press for a few minutes in the area of the puncture. Feelings of dizziness may be present after thyroid puncture. Since it does not require anesthesia or sedation, after a few minutes of recovery, you can return home without problems.
What are the complications and risks?
Puncture of the thyroid gland, according to reviews, may have consequences. The main complication is that a slight pain is felt at the puncture site. It can be treated with regular pain relief and/or local ice application.
Susceptible people may experience dizziness during or immediately after the procedure. What happens to the material obtained after the procedure? Some of the material is spread over several slides (a glass plate for microscope viewing), while the other part is stored in a special solution for further preparation for the microscope.
After processing the samples, the doctor will be able to determine the diagnosis. How long do results take? It depends on the center where you were tested, but usually from two to three days to two to three weeks. What are the possible outcomes: each center or institution may use different classifications, but the so-called system of 6 categories is most commonly used at present.
It should be borne in mind that thyroid puncture with ultrasound does not analyze tissue blocks (biopsy), but only individual cells (cytology). Thus, it is an indicative test that indicatesonly at the risk of malignancy, but the final diagnosis will always be established by biopsy with surgery.
Review results
The consequences of thyroid puncture will be presented as the following results:
- Category 1: Nondiagnostic/Poor: This category includes specimens that do not have enough material or quality to be analyzed. It represents 10-20% of punctures.
- Category 2: benign - up to 70% of punctures. The risk of malignancy is less than 3%, which virtually eliminates it. Ultrasound control will be performed after 18-24 months, and then on a case-by-case basis.
- Category 3: Includes specimens with some suspicious features and some benign. The risk of malignant neoplasms is 5-15%, although there are variations depending on the center. Sometimes a genetic test can help in this case.
- Category 4: suspicious follicular neoplasm: risk of malignancy 15-30%. Thyroid diagnosis does not fully distinguish between adenoma (benign) and follicular carcinoma (malignant), so histological examination is necessary to determine it. Surgery is usually done by at least removing the thyroid medium to make a definitive diagnosis and decide on the appropriate treatment.
- Category 5: suspicious lesions of malignantneoplasms - it represents the characteristics of malignancy, but is not enough to confirm it. The risk of cancer in this category is 60-75%. Treatment is usually surgical.
- Category 6: malignant - accounting for 3-7% of all biopsies and includes cases with conclusive cytological evidence of malignancy, including papillary carcinoma and its variants, medullary carcinoma, carcinoma anaplasia lymphoma, and metastases. The risk of malignancy is close to 100% (97.99%). Treatment is surgery.
Is it possible to get a benign result or is the node really malignant? Although rare (1-2%), a malignant nodule can lead to a benign thyroid tumor. This small risk is unavoidable, so it is very important to plan for adequate follow-up that allows endocrinologists to monitor the process. If changes in evolutionary control that suggest malignancy are observed (e.g. growth greater than 20%), a second stage or, if necessary, surgery may be performed.
If the nodule is malignant, the usual treatment is applied, although a little later. Fortunately, in these cases, the results will be almost as good. The current guidelines from the Thyroid Association (ATA) are to plan follow-up according to the characteristics of the ultrasound and the result of the puncture.
What genetic tests are used?
In recent years, have been developedgenetic methods that help determine whether a nodule is benign or malignant. These methods study several node genes in the material extracted in the puncture. These are not regularly performed today, but are usually used when the result of a puncture is uncertain.
It should be borne in mind that a genetic diagnosis is also not final, but will help determine the decision. It can be performed at the first puncture or reserved for the second puncture in case of doubt.
Summarize
One of the main reasons for the appearance of nodes, endocrinologists consider the lack of iodine. This element is necessary for the synthesis of the hormone; if the body delivers it in insufficient quantities, the body begins to work in an intensive mode and grows in size. An overactive thyroid can lead to endemic goiter.
Other causes of knots may be radiation, hereditary diseases, poor environment. If the size of the tumors is more than 3 centimeters, there may be a number of dangerous symptoms: hoarseness, shortness of breath and a constant feeling of a lump in the throat. In such cases, to examine the tumor and eliminate the risk of cancer, a thyroid nodule is punctured.
For this, the doctor makes a sample. To improve the accuracy of the procedure, an ultrasound scan is performed. Do everyone get a thyroid puncture? A biopsy may be performed on a patient with a small isolated lump if he has ever been exposed,has a propensity for hereditary occurrence of cancer or ultrasound showed the presence of a tumor.
