NCCN Guidelines for Patients
Thyroid Cancer, Version 1.2017
Tissue or fluid must be removed from your body
and tested to diagnose cancer. A biopsy removes
samples of fluid or tissue. Sometimes a sample of
tissue from the biopsy does not have enough cells to
check for cancer. It can be abnormal but not cancer.
If this happens, you may have another biopsy. Your
doctor may also consider surgery to remove the
whole thyroid lobe (about half of the thyroid).
If needed, a small sample of tissue from a lymph
node or organ is removed by incisional biopsy, core
needle biopsy, or FNA. An FNA is a type of biopsy
that uses a thin needle to take small samples of
suspicious tissue. During an FNA of the thyroid or
lymph nodes, doctors usually do an ultrasound. The
sample is then sent for testing in a lab. FNA is the
recommended form of biopsy to assess abnormal
FNA is the next step in testing if you have normal or
higher than normal levels of TSH and either:
Abnormal findings on an ultrasound
Other possible signs of cancer
Nodules smaller than 1 cm usually do not require
an FNA. You may have more ultrasounds later on
to assess these smaller nodules for growth. If the
nodules grow, you made need an FNA biopsy.
Your doctor will want to watch the nodules closely
to see if there is any change over time. If you have
a very low TSH, you may not need an FNA because
this might be a situation where the chance of cancer
is very low.
The biopsy samples will be sent to a pathologist. A
pathologist is a doctor who’s an expert in examining
cells to find disease. He or she will look at the size,
shape, type, and specific features of the cells.
Sometimes the results are not clear. Types like
follicular and Hürthle cell thyroid cancer can be
difficult to diagnose. More testing or surgery may be
Sometimes there is not enough of the sample to
confirm cancer. The results could also come back
as AUS (
This means the results are not showing whether or
not it is cancer. Thus, more testing may be needed.
Molecular testing is being used in many of these
Your doctors may look for genetic mutations such
as BRAF V600E, RET/PTC, RAS, or PAX8/PPAR
gamma. These mutations can be seen with certain
types of thyroid cancers.
The results of the lab tests, including those described
next, are recorded in a pathology report. It’s a good
idea to get a copy of your pathology report. It may
take a few days to get a copy. Your doctors will use
the results to plan further testing and your treatment.
Some people also consider a 2
opinion when it
comes to pathology results. A 2
having another pathologist review your results to
assist or confirm a diagnosis. It may be helpful to
consider this after a second FNA or another biopsy
like a core needle biopsy. A core needle biopsy may
be done if there is a concern for anaplastic thyroid