Multinodular Gland and FNA couldn't be done,pathologist didn't find the nodule

[sirenita]

I had an ultra sound that reflected a thyroid nodule; the findings are compatible with a multinodular gland. They found a 14x12x9mm nodule, a 4x5x2mm nodule and a 6X3X4mm nodule. The blood test was normal. I was referred to have a FNA on the biggest nodule (the dr. said that the others nodules were too small to worry about them). The pathologist was ready to do the test (FNA) but when he try to feel the nodule, he couldn't find it and couldn't conduct the FNA. He said that the only explanation is that maybe is behind the thyroid. He said that I need a  guide-ultra sound where the radiologist will do the FNA at the same time that they are doing the ultra sound in order to be able to see the nodule and get the cells example they need to identify is is a benign or malign. I don't know why he couldn't feel the nodule,he has been doing this for 17 years and is very competitive pathologist. What that mean? Thank you for your feedback.

[Mark Lupo, M.D.]

With a relatively small nodule 14mm in a multinodular gland, US guidance is preferred - it's not the pathologist's fault and he was right to not do a 'blind stick' and to refer you back to radiology

[azqtpies]

Hi there,


I had a partial thyroidectomy 8 days ago for a 3.0 CM nodule on my right lobe and I have remaining a 1.7 cm nodule and cyst on my left. Your nodules appear to be small as they are ( mm )and not (cm). Yes have the FNA by ultarsound guidance as this is the most accriate way to get a good result I have had three of them I first one not guided came back benign 1 yesr later had another guided  on that one and was suspicious, had it repeated at the Mayo clinic by ultrasound and all nodules were biopsied.. and the right large dominant nodule 3.0 cm, was suspicious so they suggested removal as papillary carcinoma could not be ruled out! long story short PLEASE  have it done by ultasound.... its make a huge difference... Know they can never be 100% sure of what they exactly are until they get it out and biopsy it. Good luck if you have any questions feel free to ask away... :)

Kelly~

[sirenita]

Thank you for your comments and for the information, very  helpful . I had the Guide-Ultrasound today. I handled it very well. The only aspect that I don't like is that I need to wait 4 more days to know the results. I will keep you informed. Good evening!

[GravesLady]

Those seem pretty big to me as a layperson taking into consideration that the usual lobe size is
1-1.5x1.2-1.8x4-5cm. A 2mm nodule is suspect for futher test - FNB. It is not all that unusal for a biopsy to be done with ultrasound guidance to make sure the center of the nodule is biopsied. So I consider your doctor a wise one for passing on something he felt he couldn't handle.

Hang in there!

[chinita]

I came across this info I hope it helps

SONOGRAPHY IN CONJUNCTION WITH NEEDLE BIOPSY

Fine needle aspiration biopsy of thyroid nodules has become a major diagnostic tool that is safe and inexpensive. [48,58,59,60,61,62] Ultrasound has made placement of the needle more accurate especially for small or complex nodules.

Employing Doppler technique to identify and avoid puncturing blood vessels in the region of a nodule provides a distinct advantage of ultrasound-guided aspiration over palpation-guided biopsy. This precaution reduces the amount of blood in the aspirate and facilitates interpretation of the cytology. [66]

Needle biopsy with ultrasound guidance is generally reserved for:

1. A small nodule in an obese, muscular, or large framed patient.

2. Nodules that are barely palpable or non-palpable

3. Nodule size less than one centimeter.

4. A nodule that is located in the posterior portions of the thyroid gland.

5. A dominant or suspicious nodule within a goiter

6. Complex degenerated nodules if a prior biopsy without ultrasound guidance has not been diagnostic.

7. Incidentalomas that have been detected ultrasonically in patients with high risk factors for thyroid cancer such as exposure to therapeutic x-ray.

8. Small lymphadenopathy.