Ultrasound Guided Fine Needle Aspiration

About the Procedure

According to the American Cancer Society, 43,720 new cases of thyroid malignancy will be detected in 2023 and over 2,120 deaths will be associated with this type of cancer. Until recently, thyroid malignancy was the most frequently diagnosed cancer in the United States. Malignant thyroid nodules are present in approximately 6% of the population and can be primarily detected through Ultrasound Guided Fine Needle Aspiration (FNA). Several of the board-certified providers at the Thyroid Center of New Hampshire in St. Joseph Hospital Endocrinology in Nashua, New Hampshire, have extensive experience performing this procedure. FNA uses sound waves to locate a nodule or abnormality within the thyroid to remove a tissue sample for further examination under a microscope.

During the Procedure

Mikhail Signalov, DO, of the Thyroid Center of New Hampshire at St. Joseph Hospital Endocrinology in Nashua, New Hampshire, performs this procedure in office under ultrasound guidance. In the majority of cases, this procedure is performed with very thin (27 gage) needles, which are used for obtaining thyroid cells for further analysis. In order to receive accurate results, Dr. Signalov will use at least four needles to evaluate one nodule. The needles are visualized on the ultrasound screen throughout the entire procedure, which make complications extremely rare. A study conducted at Mayo Clinic states that based on 585 procedures, 90% of patients level of discomfort was only a 2 (on a scale of 1-10) regardless of using local anesthetics or not.

Risks Associated

The risks of having an Ultrasound Guided Fine Needle Aspiration are minimal and can include local soreness, bruising, bleeding, or infection. One of the most common issues is non-diagnostic results, which can happen if not enough cells are collected during the initial sampling. However, this issue is extremely rare and is accounted for less than 5% of biopsies. Our board-certified providers at the Thyroid Center of New Hampshire at St. Joseph Hospital Endocrinology in Nashua, New Hampshire, recommend that you return to normal day to day activities after the procedure. If you develop any complications, please contact our office immediately.

Post-Procedure

After the Ultrasound Guided Fine Needle Aspiration is performed, the specimens obtained are sent to the Outpatient Pathology Associates (OPA) in California, our leading experts in thyroid cytopathology. Cytology results are usually reported within 7-10 business days. In most cases, the pathologist is able to provide a definite diagnosis of the nodule, in which our board-certified providers will review and configure a proper treatment plan. However, in approximately 25% of cases, results return as indeterminate (ambiguous). The risk of malignancy associated with indeterminate cytology can be up to 30%.

Genetic Testing

In the past, patients who were diagnosed with indeterminate nodules required a repeat Ultrasound Guided Fine Needle Aspiration or surgical resection of at least half of the thyroid gland. With the advanced technology at the Thyroid Center of New Hampshire at St. Joseph Hospital Endocrinology in Nashua, New Hampshire, genetic analysis can be performed to avoid unnecessary surgery risks that come along with it. In most cases where no mutations were found, molecular genetics suggest minimal (usually 3%) risk of cancer and instead of surgery, allows for patients to continue conservative follow-ups with their providers.

“Dr. Signalov is the best! He actually listens to patients. He is very personable, genuine, and experienced. He won’t push any unnecessary tests, procedures, or medications on you.” – Deepti