The Columbia Thyroid Center offers a streamlined way of evaluating thyroid nodules. Under the guidance of Jennifer H. Kuo, MD, Director of the Thyroid Biopsy Program, this unique clinic features multidisciplinary collaboration to provide rapid on-site performance and evaluation of fine needle aspiration biopsies.
What is the thyroid biopsy clinic and why is it unique?
Thyroid nodules are relatively common, identified in up to 30% of the population. The majority of thyroid nodules are benign, however, 5-15% prove to be malignant. For many thyroid nodules, a fine needle biopsy is the most important step in making a diagnosis and subsequent treatment plan. Typically after a physician has identified a thyroid nodule by ultrasound, it can take weeks, if not months, for a patient to have their biopsy. However, the Biopsy Clinic at the Columbia Thyroid Center provides an efficient and well-organized single-day process that eliminates the need for multiple visits
At the single-day clinic, experts perform the ultrasound, decide whether the findings require a biopsy, and if needed, perform the biopsy. The team collaborates with an onsite cytopathologist (a pathology specialist who studies and diagnoses disease at the cellular level), who determines if an adequate sample was obtained or if another sample is needed. This immediate feedback can reduce the number of passes with the biopsy needle and save people the possibility of repeat visits to obtain more samples. Results are typically available in 2-3 days.
“Our goal is to provide quality, convenient care to our patients – in essence one-stop shopping” says Dr. Kuo.
When does a thyroid nodule require biopsy?
Upon a formal ultrasound, a specialist will examine the size and characteristics of the nodule. If it is larger than a specific size or possesses suspicious features such as irregular margins, calcifications, or a solid consistency, the nodule may be deemed at risk for cancer and require biopsy.
On occasion, a patient may not have a specific nodule, but they may be experiencing symptoms such as severe pain or a rapidly enlarging thyroid. In these cases, biopsy may be suggested as well.
How is a thyroid biopsy performed?
Fine needle aspiration biopsy, or FNA, is the method of choice for evaluation of thyroid nodules. This is a minimally invasive procedure that extracts cells from the lesion for microscopic examination. During FNA, a tiny needle (smaller than those used to draw blood) is used to remove a sample of cells from the thyroid nodule, precisely localized under ultrasound guidance. The procedure is highly accurate, fast, scar-free, and safe. Most patients report that it typically feels like a small pinch, and does not usually require anesthesia. Safe for all ages, FNA is an outpatient procedure requiring no patient preparation and allows people to resume normal activity immediately.
What is molecular testing?
Fine needle aspiration allows the assessment of cellular morphology and is able to identify benign nodules in 62-85% of thyroid nodules, enabling patients to avoid unnecessary surgery. However, 15-30% of fine needle aspirations yield indeterminate cytologic findings. Additional molecular testing of these cytologic specimens can be performed and used to further guide decision-making for patients with indeterminate nodules. Currently, the Columbia Thyroid Biopsy Program offers BRAF gene testing and Afirma®. BRAF is a gene mutation that is found in 44% of all papillary thyroid cancers. Afirma is a gene expression classifier test.
How can I find out more about thyroid nodules and where to get evaluated?
Call (212) 305-6969 to schedule an appointment at the Biopsy Clinic or to learn more about our services.