View Full Version : Biopsy by endocrinologist or surgeon?
03-30-2011, 04:00 PM
For a biopsy of thyoid nodules, I read that an endocrinologist is best, using fine needle biopsy. But my friend's family doctor wants her to have a biopsy done by a general surgeon. He says that fine needle biopsy is not always accurate. Any opinions here on the board?
03-30-2011, 04:17 PM
My thyroid biopsies were done by the surgeon who removed my thyroid. No pain killer, big-ass needle, but still not unbearable.
ETA: She (the surgeon) specialized in breast and thyroid surgery.
03-30-2011, 04:53 PM
I send my patients to an interventional radiologist. They have a very efficient center where the pathologist and the radiologist work together. The most important things are the following:
Needle biopsies are usually done under ultrasound guidance
Pathology needs to be available as slides usually need to be fixed immediately
The more biopsies the doctor does the better the results
That said, I probably wouldn't use a general surgeon for thyroid surgery anyway. They might do 1 or 2 thyroids a month. The surgeon I use only does thyroid and parathyroid and probably does 10 a week. You would usually find that ENTs have more experience with thyroid surgery.
ETA: Fine needle biopsy done well is usually fairly accurate but it depends on the reasons for the biopsy. It wouldn't hurt to get a second opinion from an Endocrinologist and may be worth doing a needle biopsy (which is one step above drawing blood) prior to committing to an open biopsy with increased risks of injury and scarring.
03-31-2011, 09:19 AM
Pathologist here (I see a lot of thyroid pathology, both fine needle aspirates and thyroid resections (and the occasional needle core biopsy).
By far the best quality thyroid fine needle aspirates (FNAs) I see are the ones performed by interventional radiologists under ultrasound guidance. I've gotten variable quality from office FNAs by surgeons and endocrinologists, some of which are very poor in material and not diagnostic. (I used to do thyroid FNAs myself, so I know the difficulties involved, especially if the nodule/mass is not obvious on external exam). So I agree with psychobunny for the most part. The pathologist does not have to be on site at the time the FNA is done. What's important is that the place the FNA is done has radiologist(s) and pathologist(s) who are both experienced via a high volume of thyroid cases.
The great majority of thyroid nodules are benign. You don't want to have a big hunk (or all) of your thyroid taken out unnecessarily, which is where thyroid FNA can be helpful. If there's a malignancy the FNA is generally very accurate. Lots of FNAs are characteristic of nodular goiters, which are diagnosed as benign and typically get surgical intervention only if they are causing clinical symptoms like pressure symptoms/shortness of breath. Follicular tumors (benign or malignant) may have diagnostic cytology that leads to surgical intervention. Unfortunately, many thyroid FNAs fall into a gray area between goiters and follicular neoplasms, the cytology is called "atypical" and the clinician may choose to watch the patient and repeat the FNA somewhere down the line.
I should mention that thyroid FNAs are done with a very skinny needle, and if a local anesthetic is used the procedure should be minimally painful. Larger bore needles are sometimes used to take out a core of tissue, which potentially is more painful and can cause more bleeding (this procedure is used far less than FNAs).
03-31-2011, 11:44 AM
Jackmanii - When that needle is heading for your throat it looks very big indeed! :eek: The surgeon who did mine took about 5 sticks, guided by ultrasound. The thyroid removal was planned because I was having a lot of difficulty swallowing. It felt like I was wearing a tight turtleneck sweater I couldn't remove.
My sister, nephew and aunt have had thyroid cancer. Although they did a full (rather than partial) thyroidectomy on me, there was no sign of cancer. My sister, they did a partial (breathing and swallowing issues) with the endcrinologist telling her over and over that there was no chance she had cancer, and implying she was making up the symptoms she had. The first surgery found cancer. Although they assured her they were sure they got it all, she had them go back in and remove the whole thing, since she'd also just finished treatment for breast cancer. No radiation was done. A year later, and it had started to regrow. A third surgery, and radiation to kill the damned thing.
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