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Diagnosis of thyroid carcinoma

Thyroid carcinoma is diagnosed by ultrasonography and needle biopsy. Needle biopsy is a procedure to evaluate thyroid nodules to make the benign/malignant differentiation of the nodule. Ultrasonography and needle biopsy are the gold standard tests to make this differentiation. Needle biopsy is the procedure of collecting cells from the nodule with the help of an injection needle and examining them under the microscope.   The biopsy decision for a nodule is made according to the findings revealed in the ultrasonographic examination.

Ultrasound-assisted needle biopsy increases accuracy of diagnosis. Manual biopsy without ultrasound causes insufficient cell collection and performing biopsy of suspicious sites. Because some nodules are fluid filled and because of not having sufficient cell in the fluid parts, the diagnosis cannot be made.

  The slides prepared from needle biopsy are examined under microscope by pathologists. To be able to make the diagnosis, there should be sufficient cell in the specimen. Ultrasound-assisted biopsy increases the rate of collecting sufficient cell. Ideally, pathologist should participate in the biopsy procedure and inform whether there is sufficient number of cell or not. However, since this procedure costs too much and takes longer time, it cannot be widely performed all over the world.

Biopsy is performed in cases of hypoecogeneity, microcalcification, irregular border, spread to surrounding tissues, suspicious lymph nodes in the neck, absence of halo, intranodular high flow rate visualized by Doppler US. B

Biopsy should be absolutely performed for those with hard nodule in the neck, rapidly growing nodule, hoarseness, exposure to the neck area.

Interpretation of biopsy results

Benign: means noncancerous nodule

Malignant: means cancerous, cancer risk is 95%. Surgery is recommended.

Suspicion of malignancy: means malignant, cancer risk is 85-90%. Surgery is recommended.

Atypia of undetermined significance: cancer risk is 5%. 2-3 months later the biopsy is repeated and if the result came back same, surgery is recommended.

Follicular neoplasm: cancer risk is 20-40%, surgery is recommended.