Thyroid Ultrasonography and Fine Needle Aspiration Biopsy: A Practical Guide and Picture Atlas

Ultrasound-Guided Fine Needle Aspiration Biopsy

Author(s): Samer El-Kaissi and Jack R Wall

Pp: 51-57 (7)

DOI: 10.2174/9781681086859118010007

* (Excluding Mailing and Handling)

Abstract

UG-FNA biopsy of the thyroid and CLNs is a safe and inexpensive procedure that can be performed in the office. Complications such as hematoma and severe pain are uncommon and the procedure provides a greater yield and is more accurate than FNA by palpation. A baseline thyroid ultrasound is essential for determining which nodules and/or CLNs require FNA biopsy and for selecting an entry path. The needle path is either parallel or perpendicular to the ultrasound beam, where the parallel path requires more practice but may be safer as it allows visualization of the biopsy needle throughout the procedure. Negative pressure ‘aspiration’ or capillary action biopsies are equally effective and a 25-27G needle is usually sufficient for solid nodules, whereas a larger gauge needle may be required for the aspiration of cystic content. The risk of a hematoma post-FNA biopsy is very low although it is important to minimize the number of FNA passes, apply gentle compression at the biopsy site after each pass, and to perform a brief ultrasound scan of the biopsy site at the end of the procedure. It is unclear if holding anti-thrombotic agents before the procedure is beneficial but it is important to ensure that in patients taking warfarin the international normalized ratio (INR) is less than 2.5-3.0 before the procedure. In addition to cytopathology, FNA biopsy allows measurement of tumour markers such as thyroglobulin and calcitonin when clinically indicated. The Bethesda system and the UK Royal College of Pathologists grading system are commonly used for reporting thyroid cytopathology.


Keywords: Anti-thrombotic agent, Bethesda, Biopsy, Benign, Capillary FNA, Calcitonin, Cytopathology, Fine needle aspiration, Hematoma, Lymph node, Malignant, Parathyroid, Thyroid, Thyroglobulin, Ultrasound.

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      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316481725 and j.to_ip >=316481725 )) and ((j.from_date <= 1740675403 and j.to_date >= 1740675403 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 12816) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316481725 and j.to_ip >=316481725 )) and ((j.from_date <= 1740675403 and j.to_date >= 1740675403 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 12816) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316481725 and j.to_ip >=316481725 )) and ((j.from_date <= 1740675403 and j.to_date >= 1740675403 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 12816)
      1msalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 2636 and `b`.`banner_from_date` <= 1740675403 and `b`.`banner_to_date` >= 1740675403 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.59msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 2636
      • 3: 1740675403
      • 4: 1740675403
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='5d8a11f2d638f365e98b0f54681a0533'
      290μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    15Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        gSGFuLI8USGigZrJrr4zmxlq62tVCAcH4lGp7glB
        uc_cart_id
        5d8a11f2d638f365e98b0f54681a0533
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/12816" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/12816
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6IjhqRlZzV3lLdUNwTHBoQmNMVlJ3bGc9PSIsInZhbHVlIjoiYkhBUldXMGpkZnVDZldhd2VRcks2MWJ0VnJPRkJ0VWtmZXAxaVZqdG1FVT0iLCJtYWMiOiIzNTBiZGRkMzRiYzQ4ZGJlZjM4NmEzMjk3MjYxMzRkNzViNDMyOTc3NTk5MjEzNTUyMDc1NDFjYzQ5YWJiYTY3IiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6IjhqRlZzV3lLdUNwTHBoQmNMVlJ3bGc9PSIsInZhbHVlIjoiYkhBUldXMGpkZnVDZldhd2VRcks2MWJ0VnJPRkJ0VWtmZXAxaVZqdG1FVT0iLCJtYWMiOiIzNTBiZGRkMzRiYzQ4" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Thu, 27 Feb 2025 16:56:43 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IkhQUnIyVk4yS2FUeUdUTkozbEtEY1E9PSIsInZhbHVlIjoicTBwTDJlMmxsQmRIdUVNeGxwUjllZHRGZGdXUUxSbU1GelF1MEgvUmJzQUxidnlneGozWDZwZ28zMzhKT2JpbUs0TzArc1dJZzduWmltZHJGbldLdEtVSHdjek1nQmUyYmcrUVFPZ2R3THNMd3FZZTVRWGQ5ZUhkblZ3Q2w2WisiLCJtYWMiOiI4YTVkNzA5ZWYyZGRjNjU3NzEzZDA4ZDBhMjM0NGVjZWZhZjJjOGJjOTAzMTdlZjE4N2JmMDExNDQyZTkwYjE0IiwidGFnIjoiIn0%3D; expires=Sun, 02 Mar 2025 04:56:43 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IkhQUnIyVk4yS2FUeUdUTkozbEtEY1E9PSIsInZhbHVlIjoicTBwTDJlMmxsQmRIdUVNeGxwUjllZHRGZGdXUUxSbU1GelF1MEgvUmJzQUxidnlneGozWDZwZ28zMzhKT2JpbUs0TzArc" 1 => "alphaeurekaselectnet_session=eyJpdiI6Ik9WMjBPMWdTZUJ2UkpxYlFiVTdnZ3c9PSIsInZhbHVlIjoiOUNNS3JFSFJiZ3ZmV0QwaWsxcldhVHBRU0lJZU44M2lvd0h6VXdqRWhwdG9Vc0xmS20zd3laTk9SMHNGb3BOa2tYL3hzT3J0eElRcWt5RERRYUtSQy8wdFhPWXhlZjl3eTdIU2d1bGVIMFRyaVdqTGtYSGl5aHIvRWVEcGdKcFoiLCJtYWMiOiJhYzJjZDhjYTI1MjVkMjUyNDAxMmUxZWQyMzRjMTVlZWZhYzdmNDMzM2M5OTM5ZDUyMTk4ZjkxMDlkOWU1MjM2IiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6Ik9WMjBPMWdTZUJ2UkpxYlFiVTdnZ3c9PSIsInZhbHVlIjoiOUNNS3JFSFJiZ3ZmV0QwaWsxcldhVHBRU0lJZU44M2lvd0h6VXdqRWhwdG9Vc0xmS20zd3laTk9" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IkhQUnIyVk4yS2FUeUdUTkozbEtEY1E9PSIsInZhbHVlIjoicTBwTDJlMmxsQmRIdUVNeGxwUjllZHRGZGdXUUxSbU1GelF1MEgvUmJzQUxidnlneGozWDZwZ28zMzhKT2JpbUs0TzArc1dJZzduWmltZHJGbldLdEtVSHdjek1nQmUyYmcrUVFPZ2R3THNMd3FZZTVRWGQ5ZUhkblZ3Q2w2WisiLCJtYWMiOiI4YTVkNzA5ZWYyZGRjNjU3NzEzZDA4ZDBhMjM0NGVjZWZhZjJjOGJjOTAzMTdlZjE4N2JmMDExNDQyZTkwYjE0IiwidGFnIjoiIn0%3D; expires=Sun, 02-Mar-2025 04:56:43 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IkhQUnIyVk4yS2FUeUdUTkozbEtEY1E9PSIsInZhbHVlIjoicTBwTDJlMmxsQmRIdUVNeGxwUjllZHRGZGdXUUxSbU1GelF1MEgvUmJzQUxidnlneGozWDZwZ28zMzhKT2JpbUs0TzArc" 1 => "alphaeurekaselectnet_session=eyJpdiI6Ik9WMjBPMWdTZUJ2UkpxYlFiVTdnZ3c9PSIsInZhbHVlIjoiOUNNS3JFSFJiZ3ZmV0QwaWsxcldhVHBRU0lJZU44M2lvd0h6VXdqRWhwdG9Vc0xmS20zd3laTk9SMHNGb3BOa2tYL3hzT3J0eElRcWt5RERRYUtSQy8wdFhPWXhlZjl3eTdIU2d1bGVIMFRyaVdqTGtYSGl5aHIvRWVEcGdKcFoiLCJtYWMiOiJhYzJjZDhjYTI1MjVkMjUyNDAxMmUxZWQyMzRjMTVlZWZhYzdmNDMzM2M5OTM5ZDUyMTk4ZjkxMDlkOWU1MjM2IiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6Ik9WMjBPMWdTZUJ2UkpxYlFiVTdnZ3c9PSIsInZhbHVlIjoiOUNNS3JFSFJiZ3ZmV0QwaWsxcldhVHBRU0lJZU44M2lvd0h6VXdqRWhwdG9Vc0xmS20zd3laTk9" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "gSGFuLI8USGigZrJrr4zmxlq62tVCAcH4lGp7glB" "uc_cart_id" => "5d8a11f2d638f365e98b0f54681a0533" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/12816" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-27 16:56:43GET/chapter/128161121917