Table of Contents Table of Contents
Previous Page  20 / 90 Next Page
Information
Show Menu
Previous Page 20 / 90 Next Page
Page Background

18

NCCN Guidelines for Patients

®

:

Thyroid Cancer, Version 1.2017

2

Testing

Biopsy

Biopsy

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

thyroid nodules.

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

or

†

†

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.

Pathology review

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

needed.

Sometimes there is not enough of the sample to

confirm cancer. The results could also come back

as AUS (

a

typia of

u

ndetermined

s

ignificance) or

FLUS (

f

ollicular

l

esion of

u

ndetermined

s

ignificance).

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

situations.

Your doctors may look for genetic mutations such

as BRAF V600E, RET/PTC, RAS, or PAX8/PPAR

(

p

eroxisome

p

roliferator-

a

ctivated

r

eceptors)

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

nd

opinion when it

comes to pathology results. A 2

nd

opinion involves

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

cancer.