Thyroid puncture is a simple procedure consisting of piercing the nodules of this organ in order to assess the risk of its malignancy. This is a fundamental test in the diagnosis of the thyroid gland, as it provides great information with virtually no risk of complications.
How is the procedure
Puncture of the thyroid gland is usually done using the “eco-oriented” method - they direct the needle with ultrasound to make sure that the organ is pierced only in the right place.
If you have problems with the thyroid gland, you need a medical consultation. When should such a 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 thyroid puncture is performed. The most important factors in determining the suspicion of a nodule and, therefore, taking a puncture, are determining the size and appearance of the organ on an ultrasound scan.
When a puncture is needed
In general, nodules less than ten millimeters in size will not be punctured unless risk factors are observed on the ultrasound (for example, “wrong boundaries” or microcalcifications).
Reviews of thyroid puncture report that large nodules (larger than 15-20 mm in size) should almost always be punctured, unless ultrasound shows that they are purely cysts (fluid sacs). In this case, puncture can 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.
It should be borne in mind that the nodes of the thyroid gland are very common problems, the vast majority of them are determined by benign. Therefore, the mission of the endocrinologist is, on the one hand, to detect suspicious nodules in order to pierce them, and on the other to avoid puncture of nodal sites with a very low probability of being malignant.
Preparation for the procedure
Thyroid puncture under ultrasound monitoring requires careful preparation. A preliminary analysis is necessary, mainly for two reasons. First examine thyroid hormones, coagulation and make sure there is no risk of bleeding. The patient should be accompanied. Some sensitive people may experience dizziness immediately after a puncture, although symptoms usually disappear in a short time.
Medicines that may interfere
It is very important to tell your doctor about all the medicines you take regularly, and if you are allergic to medicines or other products.
It is necessary to stop taking an anticoagulant (“drugs to make blood more fluid”) such as:
- "Acenocoumarol";
- Warfarin
- Dabigatran
- "Rivaroxaban";
- Apixaban
You should avoid aspirin, ibuprofen, and other anti-inflammatory drugs a week before starting the test. There is no need to take any additional medicines.
Food
It is not necessary to adhere to a special diet, although in some centers it is recommended to refuse food for about eight hours before the test. As a rule, it will be enough not to have breakfast and not drink anything before doing a thyroid puncture.
clothing
It is advisable to wear clothing with a wide neck or it can be easily opened (for example, a shirt with buttons) to free the area of the thyroid gland. Avoid wearing necklaces or other jewelry around your neck.
Pregnancy and lactation
Puncture of the thyroid gland is not contraindicated during pregnancy or breastfeeding, but it will be necessary to inform health workers about pregnancy or suspected pregnancy. Some hormones change naturally at these stages, this may affect analytics.
How is the procedure going?
If the nodule is alive, then a puncture with ultrasound control may not be possible. In some cases, nodules in the chest may be checked by puncture, controlled by CT, or a diagnostic operation may be required.
Thyroid puncture under the supervision of specialists lasts about 15-20 minutes. Obtaining the biopsy itself is very fast, the rest of the time is to prepare the material and the area to be biopsy.
Puncture of the thyroid gland node 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 facilitate hyperextension of the neck. After the patient has taken a horizontal position, a local antiseptic will be introduced, and the doctor will find the node that will be punctured with ultrasound.
The puncture is performed with a very thin needle, which should reach the thyroid gland (usually thinner than the thyroid gland). Soft movements will be performed with the needle in the assembly to aspirate the material to make sure that the tissue is removed, then the needle will also be removed. During this part of the procedure, the doctor warns the patient that he should try not to cough, swallow or speak: when the thyroid gland moves, it will be more difficult to diagnose.
Typically, two to six punctures are required, depending on the quality of the sample obtained. Thus, the entire size of the nodule is covered, and a more accurate diagnosis is more likely.
If it is a cystic ganglion, it can be emptied with a syringe to reduce size and relieve discomfort. After the puncture is completed, you will be prompted to press a few minutes in the puncture area. After a thyroid puncture, dizziness may be present. Since this does not require anesthesia or sedation, after a few minutes of recovery, you can return home without problems.
What are the complications and risks?
Thyroid puncture, according to reviews, can have consequences. The main complication is that there is a slight pain at the puncture site. You can treat it with regular anesthesia and / or ice topically.
During the procedure or immediately after it, dizziness may appear in susceptible people. What happens to the material obtained after the procedure? Part of the material is spread over several slides (a glass plate for viewing to the microscope), and 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 the results last? 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 results: each center or institution can use different classifications, but the so-called system of 6 categories is currently most often used.
It should be noted that thyroid puncture with ultrasound does not analyze tissue blocks (biopsy), but only individual cells (cytology). Thus, this is an indicative test, which indicates only the risk of malignancy, but the final diagnosis will always be established by biopsy with surgical intervention.
Results Overview
The consequences of thyroid puncture will be presented in the form of the following results:
- Category 1: non-diagnostic / unsatisfactory: this category includes samples that do not have enough material or enough quality to be analyzed. It represents 10-20% of punctures.
- Category 2: good quality - up to 70% of punctures. The risk of malignancy is less than 3%, which virtually eliminates it. Ultrasonic testing will be performed after 18-24 months, and then for each case specifically.
- Category 3: includes samples with some suspicious signs and some benign. The risk of malignant neoplasms is 5-15%, although there are changes depending on the center. Sometimes a genetic test can help in this case.
- Category 4: suspicious follicular neoplasm: the risk of malignancy is 15-30%. Diagnosis of the thyroid gland does not completely distinguish between adenoma (benign) and follicular carcinoma (malignant), therefore, to determine it, it is necessary to conduct a histological examination. Surgery is usually performed, at least by extracting the thyroid medium, in order to make a final diagnosis and decide on the appropriate treatment.
- Category 5: a suspicious lesion of malignant neoplasms - it presents the characteristics of malignancy, but not enough to confirm it. The risk of cancer in this category is 60-75%. Treatment is usually surgical.
- Category 6: malignant - it accounts for 3-7% of all biopsies and includes cases with convincing cytological signs of malignancy, including papillary carcinoma and its variants, medullary carcinoma, anaplase carcinoma lymphoma and metastases. The risk of malignancy is close to 100% (97.99%). Treatment is an operation.
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 inevitable, therefore it is very important to plan an adequate observation, which allows specialists in the field of endocrinology to control the process. If changes in evolutionary control, which suggest malignancy, are observed (for example, an increase of more than 20%), a second stage can be performed or, if necessary, surgery.
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. Current recommendations from the Thyroid Association (ATA) come down to planning for follow-up according to the characteristics of the ultrasound and the result of the puncture.
What genetic tests are used?
In recent years, genetic methods have been developed to help determine if a nodule is benign or malignant. These methods study several host genes in the material extracted in the puncture. Today they are not performed regularly, but are usually used when the result of a puncture is uncertain.
It should be borne in mind that the genetic diagnosis is also not final, but will help determine the decision. It can be performed at the first puncture or reserved for a second puncture in case of doubt.
To 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 organ begins to work in an intensive mode and grows in size. Excessive thyroid activity can lead to the formation of endemic goiter.
Other reasons for the formation of nodes may be radiation, hereditary diseases, poor environment. If the size of the tumors is more than 3 centimeters, there can be a number of dangerous symptoms: hoarseness, shortness of breath and a constant feeling of a lump in the throat. In such cases, in order to examine the tumor and eliminate the risk of cancer, a thyroid nodule puncture is performed.
For this, the doctor makes a sample. To increase the accuracy of the procedure, ultrasound scanning is performed. Does thyroid puncture do everything? A biopsy can be performed for a patient with a small isolated seal, if he has ever been exposed, has a tendency to hereditary cancer, or an ultrasound scan reveals a tumor.