Possible Cancerous Nodule

[jeanette1952]

I am a 67 year old female with a 2.2 cm cystic/solid nodule on left thyroid. Borders are smooth and there are a couple of tiny calcifications. This was exactly what the ultrasound stated (other than measurements of the thyroid). The radiologist suggested an ultrasound guided biopsy to exclude possibility of neoplasm (cancer). From this description does this sound like cancer? I am going on 4/15/19 for the biopsy. Do they do these in their office or in a hospital setting? Never had a biopsy before. Very scared and anxious. Any responses would be greatly appreciated.

[Sarahjogs]

Hi jeanette1952,

I'm sorry you are going through this - I had a biopsy last year for thyroid nodules and the biopsy was the worst part of my whole diagnosis pathway (I eventually had my thyroid removed) because the not knowing was so much more stressful for me than anything else.  There is no way of knowing whether your nodule is cancerous or not without doing the biopsy, but we do know what percentage of nodules usually end up being cancerous and that may help you with some of your anxiety about this.

Most thyroid nodules are benign (90-95% are benign).  When thyroid nodules are larger than 2 cm, the risk of cancer increases to 15%, which means that 85% of thyroid nodules are still benign, but it is important to do a fine needle biopsy to catch those ones that are cancerous.

I was told by my ENT that 20% of 20 year old women have nodules, 30% of 30 year olds, 40% of 40 year olds, etc., so thyroid nodules are actually quite common in women, most women don't know they have them, and most of them end up being benign.

I had my biopsy done by a pathologist in a doctor's office, not in a hospital, but I think it could be in either location.  The pathologist did another full thyroid ultrasound, and then numbed the area with something like lidocaine (I don't remember what the numbing agent was), and then used a very thin needle to remove some cells.  My aunt had the same procedure done (she lives in a different area) and hers didn't involve the numbing agent, so I think either method is a possibility, but maybe most places are moving towards not using a local anesthetic.  The needle that they use for the biopsy was much thinner than the needle he used to numb it, so I think it would have been less painful without the numbing part, but I'll never know.

For each nodule biopsied (I had two tested, one on each side), the doctor numbed the area and then did two biopsies with biopsy needles, which are very thin. The whole procedure was a little bit painful, but I knew it was necessary to figure out what was wrong with my thyroid.  My neck was sore for a couple of days after, but I think that was mostly due to the fact that one of my nodules was protruding way out to the left side of my throat and he had to go through some muscle tissue which was a lot more painful than the nodule that was easier to access.

At this point, there is a good chance your nodule is benign, and until you get a biopsy there is no reason to assume that it is a neoplasm or cancer.  Cancer is one possibility and I know it can cause a lot of anxiety, but most nodules are not cancerous, so until you know otherwise I would try to keep that in mind.  Good luck with your biopsy, I hope all goes well for you.

[jeanette1952]

Thanks so much. Your response was knowledgeable and uplifting.

[BigDrew86]

Unfortunately, you haven't provided enough information. Typically, cancerous nodules have increased vascularity (meaning blood is going through them), they're hypoecholic (meaning they do not refract sound sufficiently, and will have somewhat irregular borders. Unfortunately, as others pointed out, you won't know for sure it's cancerous until an FNA or surgery is performed. Try to have a hospital with an interventional radiology department perform the FNA. They're often better at getting enough sample to review.

My 2 nodules had all of the features I just listed. Went in for an FNA, had results within 48 hours it was PTC (papillary thyroid cancer), and was in for surgery 1.5 weeks later.

[Sarahjogs]

Increased vascularity, calcifications, hypoechoic, irregular edges are all associated with an increased risk of cancer, but does not mean a nodule with those features is cancerous, nor does it mean if you don't have those features it is not cancer.  It is impossible to diagnose whether the nodule is cancerous or not before the FNA.

Plenty of benign nodules have vascularity and calcifications, and two of my "isoechoic" nodules were cancerous.  I had three nodules diagnosed with papillary thyroid cancer, and not one of them had irregular edges, calcifications or increased vascularity, and only one was hypoechoic.

[Gracevd70]

Sorry.... Depends on where and who is doing your biopsy ....I had first 2 done by ENT and this was very bad choice since this particular office was lousy at biopsy...my cancer diagnoises biopsy was done at Endocrinologist office without any medication or numbing agent took about roughly 30 mins maybe longer can't recall and pathologist did a second exam on the samples .  Most clinics will give you numbing agent but if you can handle the needle without like me you should be ok....everyone is different.

[Gracevd70]

Hi
Its hard to say if it's cancer or not until you have the biopsy. I lost my thyroid to cancer in 2016 and I hope you don't have it ...life has sucked for me after thyroidectomy.  

Think Good thoughts ♥️