FNA

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Dr. Norbert KURLAND

FAN is an abreviation for Fine Needle Aspiration Biopsy. Ultrasound is used to guide a needle into a thyroid nodule suspected of cancer, removing a small sample of thyroid cells that is sent to the lab for cytopathology analysis. Thyroid nodules are common, for times more common in women than in men, and their prevalence increases with the age. About 60 % of people 50 years of age have a thyroid nodule, and 80 % of people who are 70 years old will have a thyroid nodule. Most thyroid nodes (90% to 95%) are benign. When FNA is necessary, and what a FNA biopsy can tell us ?

FNA needle biopsy of thyroid nodules is generally done on any thyroid nodules that is big enough to be felt. This means that they are larger than about 1 centimeter (about ½ inch) across.
FNA needle biopsy should be done on thyroid nodules that have ultrasound features that strongly suggest malignancy including hypoechoic echogenicity, solid composition irregular margins, microcalcifications, extrathyroidal extension, and cervical lymph nodes with suspicious features, FNA needle biopsy can also be done on lymph nodes.

FNA should not be performed on nodules smaller than 1 cm.

Based on ultrasound characteristics, the TRIADS is a scoring system used for the selection of nodules for FNA and classification of the risk of malignancy. TIRADS is an abbreviation for Thyroid Imaging Reporting and Data System. TIRADS 1 is a normal examination, TIRADS 2 and 3 are benign features, TIRADS 4A light suspicion of malignancy, TIRADS 4B strong suspicion of malignity, TIRADS 5 means cancer. The BETHESDA is a standard reporting system that studies the sample of cells under microscope for cytologic diagnosis of risks for malignancy (from 1 to 6). There is a general concordance between BETHESDA and TRIADS categories. Combined use of TRIADS and BETHESDA is efficiency to consider a surgical decision or to continue ultrasound monitoring.

Finally, if we consider the metabolic aspect, the hyperfunctioning nodules, called ‶hot″ nodules, identified by a radionuclide thyroid uptake scan, indicative of hyperthyroidism, are rarely malignant and do not require FNA. Nodules in patients with a normal or high TSH level, indicative of hypothyroidism, may require FNA based on their ultrasound characteristics and their sizes.

FNA is a safe, minimally invasive and risk-free procedure, it can be performed in pregnant women.

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