What is the purpose of puncture of the thyroid gland for nodules? What is thyroid puncture

Despite the introduction of new methods of diagnosing diseases into medical practice thyroid gland, puncture (puncture biopsy) remains an indispensable research method. If the rules are followed, the procedure is safe for the patient, and its result is necessary to establish an accurate diagnosis. It allows you to choose treatment tactics for the identified disease and control this process.

What does a thyroid puncture show?

Puncture (fine needle aspiration biopsy) of the thyroid gland allows you to obtain cells from a pathological focus detected during an ultrasound scan of the organs of the anterior surface of the neck and examine them under a microscope. This diagnostic method identifies and makes it possible to study the structure of nodes in which thyroid epithelial cells have undergone transformation into cancer.

The puncture itself is a layer-by-layer puncture of the skin of the anterior surface of the neck, subcutaneous fat and thyroid tissue, carried out under ultrasound guidance. When performing a study, the doctor has the opportunity to detect suspicious areas of tissue of this endocrine organ and obtain material from the desired area.

Main advantages and disadvantages of the analysis

The main advantages of the FNA method (fine needle aspiration biopsy) include:

1. Availability. To perform the procedure, you only need an endocrinologist with experience in performing this diagnostic procedure, an ultrasound machine with a sensor for examining the neck organs, an aspiration needle and a syringe.
2. Relatively cheap. The method does not involve the use of expensive equipment and consumables.
3. Speed ​​of research. Viewing slides with prepared cytological preparations does not require much time.
4. Possibility of double-checking the obtained result. Slides can be preserved under normal conditions for an almost unlimited time.

That is why fine-needle aspiration biopsy remains an important screening method for examining patients when nodular neoplasms are detected in the thyroid tissue. The result of the analysis makes it possible to identify the early stages of thyroid cancer and carry out timely treatment this terrible disease.

Screening is an accessible examination of a large number of patients.

However, there are significant disadvantages of this method, which include:

1. False negative research results. If the established procedure is not followed, tumor fragments may not be included in the resulting aspirate, so the procedure shows the absence of malignant cells, and the time to start therapy is delayed.
2. Development of complications. A hematoma may occur at the site of TAB (as a result of bleeding from a damaged small-diameter vessel), as well as suppuration if aseptic rules are not observed during medical procedures.

The use of thin needles for biopsy reduces the likelihood of pain during the procedure, so there is no need for anesthesia (local or general). Currently, pain relief, carried out with the help of creams or sprays, which include local anesthetics (Lidocaine, Xylocaine, etc.), is used when performing diagnostic puncture in children.

When can thyroid puncture be performed?

Despite the frequent detection of nodular neoplasms in the thyroid tissue, there are clear indications for performing an aspiration biopsy:

1. Detection during palpation of the neck or holding ultrasound diagnostics nodular neoplasms whose diameter exceeds 1 cm.
2. If the size of the identified pathological focus is less than 1 cm, then the procedure is recommended for patients in the following cases:
   • work related to ionizing radiation, or living in areas that have been exposed to radiation;
   • hereditary predisposition - experts have proven that oncological diseases thyroid disease is often diagnosed in members of the same family;
   • detection by ultrasound of calcifications or a node with clear signs malignant degeneration of tissues, that is, blurred contours, uneven increase in blood flow.

Pathology is detected in 50% of patients aged 40 years, and in older age groups even more often.

Contraindications to puncture biopsy are relative - endocrinologists recommend that women refrain from performing the procedure during or on the eve of menstruation. If a patient is diagnosed with blood coagulation disorders, then TAB is performed after their correction. It is not recommended to do a puncture for ARVI or other infectious diseases.

The safety of the procedure is also proven by the fact that a biopsy is possible in children, even the most early age, as well as during pregnancy and lactation.

How to prepare for the procedure

A needle biopsy of the thyroid gland is not required. special training. Therefore, the patient does not need to limit himself in food and liquid intake. However, experts recommend reducing physical activity(it is enough to refuse training on the eve of the puncture).

To study the structure of thyroid tissue, it does not matter what time of day the diagnostic procedure is performed (this FNA is fundamentally different from studying the level of thyroid hormones, which should be performed between 8 and 10 o’clock). If the patient shows signs increased anxiety, then the endocrinologist prescribes sedatives made from plant materials (valerian root extract, Novo-passit, Persen).

Features of the event

An important condition for the correct execution of the diagnostic procedure is visual control carried out using a sonographic sensor. The only exception to this rule is considered to be very large nodes, determined by palpation of the neck, but even in this case, ultrasound control allows the endocrinologist to choose optimal places for carrying out TAB.

If the puncture is performed correctly, the cells of the connective tissue capsule of the organ and the glandular colloidal epithelium, responsible for the production of thyroxine and triiodothyronine, should enter the aspiration material. That's why an important condition the accuracy of the result becomes correct position patient's body. To achieve maximum neck extension, it is necessary to place a special cushion under the patient’s shoulders. Treatment of the skin with an antiseptic and a small pressure bandage, applied to the needle insertion site (it can be replaced by fixing a gauze swab with your finger).

The whole process is controlled on the monitor of an ultrasound machine - first, the zones of change in the thyroid tissue, the number of pathological foci, and the features of their structure are determined. Then, one by one, a biopsy needle is inserted into each pathological formation whose size exceeds 1 cm.

Upon receipt, the aspirate from each punctured formation is applied to a separate glass slide.

Puncture of the thyroid gland under ultrasound control - video

Frequent complications and dangerous consequences

Statistics prove that the most common complications of needle biopsy are:

1. Subcutaneous hematoma at the site of needle insertion. To reduce the likelihood of its formation, a needle with a minimum diameter is used for biopsy, and the patient is also recommended to press on the tampon placed at the puncture site for several minutes.
2. Sore throat (injection area). Its occurrence is prevented by applying drugs that have a local anesthetic effect to the skin.
3. Temperature increase. Endocrinologists explain this as general reaction organism (manifests in short-term episodes, goes away on its own), and the development inflammatory process at the injection site. For prevention, it is recommended to treat the puncture site with antiseptic solutions and limit the intervention area with special sterile napkins.

You can often hear the opinion of people who are far from medicine that performing TAB increases the risk of developing thyroid cancer. This position is wrong. On the contrary, performing a puncture of the thyroid gland allows you to timely detect cancer in the early stages and carry out surgical and conservative treatment potentially dangerous disease.

The endocrinologist prescribes control studies as needed. If no pronounced negative dynamics in the development of the disease are detected, then a puncture biopsy once every 12 months is sufficient.

Decoding the results after the study

Cytology result describing:

• what kind of cells were found in the aspirate, their ratio and structural features;
• whether pathological changes have been identified.

The cytologist certifies the data obtained with his signature. In conclusion, the doctor indicates what percentage of colloid epithelial cells (tissue that produces hormones) is in the sample taken, and whether there are cells with signs of malignant degeneration or cancerous ones. In addition, it describes the structure of the connective tissue membrane of the organ, the presence of pathological inclusions in it (hemorrhages, deposition of calcium salts, etc.)

Depending on this, a conclusion is made whether the node is a benign or malignant neoplasm (with a determination of the type of thyroid cancer). If the cytologist has doubts about the result obtained, then this fact is also reflected in the document, recommending a repeat biopsy. The endocrinologist who monitors the patient should make a final diagnosis, taking into account the clinical picture of the disease and the results of the puncture biopsy, and recommend further treatment tactics.

The article is devoted to one of the most effective examinations of various thyroid tumors - fine-needle aspiration biopsy. It contains information about the instruments used for this manipulation, the course of the procedure, indications and contraindications for it.

The result of thyroid puncture with interesting photos materials and videos in this article.

The thyroid gland (glandula thyreoide) is a small organ endocrine system located anteriorly and on the sides of the trachea. In a normal state, it is practically undetectable during palpation examination.

Among the pathologies of other endocrine glands, diseases of glandula thyreoide are the most common. The situation is complicated by the fact that such diseases can occur in a hidden or latent form.

And often the only sign that will indicate to the patient that not everything is in order with his thyroid gland is an enlargement of this organ. And the most accurate way to find out exactly what caused this phenomenon is to use a fine-needle aspiration biopsy (FNA).

Unfortunately, one of the most dangerous diseases of the thyroid gland, nodular neoplasms, is becoming increasingly common. Among women over fifty years of age, the incidence of nodes reaches 50% of the population. With increasing age, this figure only increases.

As for the malignant degeneration of these neoplasms, it occurs in 5–6% of cases.

Medical tactics no longer provide for complete cleansing of the gland tissue from pathological formations, but focuses on accurate diagnosis and combating only those that have entered the process of degeneration or have grown so large that they have begun to pose a threat to the functioning of surrounding organs. And this is where a puncture of the thyroid gland comes in handy, the research results obtained from which will help determine which node should be urgently removed and which one can be left alone for now.

Indications for TAB

Aspiration biopsy is performed in mandatory in the presence of the following neoplasms:

• cystic;
• anyone whose symptoms indicate a malignant course;
• nodular, having a diameter of 10 millimeters or more, detected using ultrasound or manual examination;
• nodular, identified during or palpation examination with signs of malignant degeneration, less than 10 mm in size.

Table: Indications for thyroid puncture:

In these cases, you should not delay the study, because not only the health, but also the very life of the patients is at risk.

What determines the price of a thyroid node biopsy? The cost of a diagnostic puncture is exactly the same: 3000-6000 rubles.

This cost variation is formed as follows:

1. biopsy “with” or “without” control ultrasound examination;
2. how many formations need to be punctured;
3. methods of cytological research;
4. urgency of the procedure and results.

Cytological examination of a suspension of cellular material is lower in diagnostic efficiency than histological examination of thyroid tissue. In some cases (this is rare), the material obtained for microscopic examination may be of poor quality, that is, it may contain fragments of cells and serous fluid, which is not a sufficient argument for surgical resection of the affected part of the organ.

A piece of tissue taken for research contains a number of cells from which the structure and nature of the pathology can be determined. It is this analysis that is an indication for surgical intervention.

Progress of the study

The peculiarity of this technique is the collection of biological material for further research using a needle of a particularly small diameter, which is why it is called fine-needle aspiration biopsy.

Advantages of FNA over other methods for examining thyroid nodules:

• Easy diagnostics. Medical instructions to this diagnostic method indicates the absence of special sophisticated equipment for the study. The duration of the manipulation itself is 2-5 seconds.
• Low price of the procedure. The cost of a puncture biopsy is slightly higher than the cost of an ultrasound examination of the thyroid gland.
• Practically complete absence contraindications and complications.
• Absolute reliability of survey results. This is the only method for establishing a definitive diagnosis.

Material collection can be performed using two control methods:

• palpation;
• ultrasonic

Currently, doctors have almost completely abandoned the use of the first method, due to its low accuracy, and use ultrasound equipment in their practice.

Consumables

For this manipulation, disposable syringes are used, ten or twenty cc with needles having a diameter of 23G and below, up to 21G.

Important! The thinner the needle used for puncture, the less pronounced painful sensations from a puncture and the less blood from the injured gland tissue gets into the puncture.

Anesthesia

Standard instructions for performing TAB do not provide for anesthesia, since the duration of the manipulation, if performed by an experienced doctor, does not exceed 2–5 seconds, and the diameter of the needle is so small that its insertion practically does not cause pain.

Important! Carrying out anesthesia, both general and local injection, during TAB does not make sense also because the pain during parenteral administration of the anesthetic exceeds that during the puncture itself. Plus, possible complications from pain relief make it much riskier than the collection of biological material itself.

The only justified method of anesthesia is the use of anesthetic creams with prilocaine, xylocaine or lidocaine in the form of sprays or creams applied to the skin 60 minutes before the procedure.

The total duration of TAB is up to a quarter of an hour, but the vast majority of time is spent filling out written and electronic documentation:

Examination stage	Manipulations performed
	Patient registration, explanation of the FNA technique
	Giving the patient a comfortable position - lying on the treatment table, with the ability to adjust the angle of inclination and height with a small pillow under the back, which allows for sufficient extension of the neck. Treatment surgical field antiseptic and separating it from the surrounding skin surface using a sterile napkin. Ultrasound examination of the gland and the puncture itself under the control of ultrasound equipment.
	No special manipulations are required at this stage, except for manually fixing a sterile cotton ball at the puncture site skin for five minutes and you can safely go home.

The main requirement for all stages of TAB is compliance with sterility standards, which will be discussed in more detail in the next paragraph.

Sterility during FNA

In order to prevent the patient undergoing examination from becoming infected with all kinds of blood infections, such as HIV or hepatitis B, all stages must be carried out in strict accordance with the requirements of the sanitary-epidemiological regime.

The most problematic item in this regard is the ultrasonic sensor, the complete disinfection and sterilization of which is quite problematic. Most often, the destruction of pathogenic microorganisms that have reached it is carried out by immersing the sensor in a disinfectant solution, which does not guarantee one hundred percent destruction of pathogens. Therefore, the further a patient is in the queue for TAB, the higher his chance of getting an infection from one or even several previous patients.

The likelihood of nosocomial infection is even higher if puncture attachments are used on an ultrasound sensor, through which a puncture needle is passed in order to increase the accuracy of hitting the node. However, during the reverse stroke of the needle biological fluids from the surface, the needles remain inside the puncture nozzle, and removing them from there is very problematic.

The only suitable method for this purpose is autoclaving, which is very rarely used in medical centers.

Therefore, to undergo FNA, you should only contact those medical institutions that practice biopsy using the “free-hand” technique. The essence of the method is to protect the ultrasound sensor using a disposable sterile cover, worn and disposed of in the presence of the patient.

In this case, the doctor does not use guides for the puncture needle, holding it in one hand and the sensor in the other. An experienced specialist with developed skills and under such conditions will easily get to the desired node, while reducing to zero the likelihood of nosocomial infection of the patient.

Frequency of procedure

Answering the question of how often a puncture of the thyroid gland can be done - usually the procedure should be performed once in order to minimize damage to the organ tissue. However, there are exceptions. If a benign node was diagnosed for the first time, but over time it quickly increased in size (which is not a prognostically favorable sign), a repeat fine-needle aspiration biopsy is performed to identify the cause of the accelerated growth and exclude its malignancy.

Statistical data states that the uninformativeness of a biopsy ranges from 5 to 25%, i.e. the answer obtained as a result of FNA of the thyroid gland does not give a clear answer to the question “Is the identified nodule malignant?” This situation also requires a repeat procedure at least 1 month after the initial puncture. If 3 procedures were uninformative, patients are usually advised to undergo surgical intervention to remove the node.

The consultation is usually carried out by an endocrinologist surgeon - a specialist involved in these procedures. Before TAB, he necessarily examines the patient and additionally explains how the thyroid puncture is done.

Complications of TAB

There are no contraindications to this type of research. During its implementation, the following complications are possible:

1. Phlebitis of veins.
2. Trachea puncture.
3. Infection of the puncture site.
4. Injury to the nerves located in the larynx.

All these complications can develop due to the low qualifications of the specialist performing the procedure, and experienced doctors they practically never occur.

Reading the result

The formulation of the research result may look like this:

• intermediate result;
• uninformative result requiring repetition of the study;
• benign course (if a colloid node is detected, further observation is required to exclude degeneration into cancer);
• malignant course (cancer), requires urgent surgical intervention with further treatment of postoperative hypothyroidism.

An informative result does not require repeating the biopsy; it is used to select medical tactics. If the result is benign, annual monitoring of the development of the tumor is required, and only if rapid growth is observed (more than 10 mm per year), repeat TAB is performed.

Information content of the procedure

The doctor expects a specific result from TAB, whether the neoplasm has a benign or malignant course. However, the proportion of uninformative results requiring repetition of the procedure is quite high (4 – 30%). In case of repeated uninformative results, as a rule, surgery is performed to exclude glandula thyreoideae cancer.

How to increase the information content of the TAB?

A number of medical centers, in order to increase the effectiveness of research, practice simultaneous collection of punctate from several nodes (2 – 6), which, naturally, makes the procedure much more painful.

Leading centers strive to improve the quality of TAB in the following ways:

1. Staining of preparations according to international protocols, creating the best conditions for their analysis.
2. Use up to 6 glasses for cytological smears in order to preserve the material and increase the accuracy of the research.
3. Manipulations are carried out only by the most experienced specialists with experience in performing at least 10,000 biopsies, with regular performance of 300 manipulations per week.
4. Performing a puncture according to the rule: one node, one injection, but at the same time collecting cellular material from different areas of the neoplasm, resorting to repeated injections only in the case of an excessively high density of the node.

Thanks to such innovations, the likelihood of obtaining informative results in leading medical centers has increased to 92%, exceeding the European average.

Interpretation of the result

Only an experienced cytologist specializing in the study of the thyroid gland can make an accurate conclusion on the drug, since the criteria for studying this gland differ from those for other organs.

Received biological materials classified as follows:

1. Suspicion of a malignant course with an inaccurate result.
2. Malignant degeneration of a tumor-like neoplasm.
3. Obtained from a node whose development process proceeds benignly.
4. Not suitable for research or provided in insufficient quantities.
5. Cellular material with atypical or follicular changes, the genesis of which is not clear.
6. Follicular cells that synthesize thyroid hormones involved in tumor processes.

If it is possible to thoroughly study the biopsy, the cytologist will be able to make an accurate diagnosis.

Thyroid cysts

With the help of TAB, it is possible not only to determine its type.

Signs of various types of cysts are given in the table below:

FNA for cysts, both single and multiple, acts not only diagnostic, but also medical procedure, promoting aspiration of pathological contents.

Hashimoto's thyroiditis

This disease is chronic inflammation glandula thyreoideae tissues, which are autoimmune in nature (read more). The pathology may be accompanied by the formation of nodular structures, which are examined using FNA.

The cytological picture of the disease is characterized by:

1. Infiltration of lymphocytes.
2. Atrophy of tissue parenchyma.
3. Fibrous tissue changes.
4. Development of eosinophilic changes in acinar cells.

TAB for this pathology must be supplemented biochemical analysis blood.

Benign neoplasms

The cytology of benignly developing nodes is practically indistinguishable from normal. In this case, the cytologist can formulate a description as follows. The appearance of such a neoplasm can be triggered by increased growth of individual parts of the thyroid gland, in which the structural units of the gland, thyroid glands, grow in size and turn into an adenoma.

The colloid node may undergo malignant or cystic (cystadenoma) degeneration.

Thyroid cancer

In this case, TAB helps to identify malignant tumor and determine its type. Up to 90% of cases of malignant degeneration of the gland occur in.

Its cytological picture is characterized by:

1. Multinucleation of cells.
2. Sticky colloid consistency.
3. The appearance of round cell nuclei.
4. Metaplasia of squamous elements.
5. Weakly expressed cellular polymorphism.
6. The formation of various kinds of pathological cellular structures.

Another type of malignant degeneration, follicular cancer, accounts for up to 15% of cases.

A biopsy of this pathology is characterized by:

1. Lack of colloid.
2. An increase in the size of cell nuclei.
3. Overlay of cellular elements on top of each other.
4. The appearance of nuclei shaped like a circle or oval.

Degeneration in the form of medullary cancer is rare. Its cytology is characterized by:

1. Polygonal shape of cells.
2. The presence of several nuclei within one cell.
3. Polymorphism, expressed in varying degrees.
4. Disjointed arrangement of cellular elements.
5. The production of calcitonin in neoplasm cells.

Anaplastic cancer is even less common. Its feature is uncontrolled cell growth.

Extremely rare form malignant neoplasms, - insular cancer, the basis for the formation of which is the follicular epithelium. In this case, the biopsy contains cellular elements whose structure is similar to follicles, but their size and shape are varied.

Cytology for any type of malignant degeneration allows:

1. Perform initial detection of malignancy.
2. Track all changes cellular structure glands.
3. If treatment is successfully completed, confirm recovery.

The use of FNA is not often used, only in cases where it is necessary to visually assess the cellular structure of glandula thyreoideae; the cost of the procedure is small compared to the benefits it brings.

Puncture of the thyroid gland and the research results obtained with its help make it possible to determine the pathology in 95% of cases, and moreover, this can be done at the very early stages. Which, in turn, allows you to select medical tactics in a timely manner and, with the least losses, defeat the pathology.

To diagnose any problems in the functioning of organs, a high-quality examination is necessary. This task is not always accomplished by superficial studies, such as general tests, hormone tests and even ultrasound. Testing for thyroid problems often includes a test such as a thyroid puncture. What does such an analysis provide and should we be afraid of it?

Why do a puncture at all?

A puncture of the thyroid gland, otherwise this examination is also called a fine-needle biopsy, is necessary to obtain the most accurate data on the condition of the thyroid gland. Namely, an error-free diagnosis guarantees effective treatment. Is there any point in trying different types of treatment when you can only do one test?

A fine-needle biopsy is prescribed to examine only the thyroid gland and mammary glands. This is due to the structural features of these organs. Both of these glands have a very developed circulatory system, and a puncture of an ordinary needle for tissue sampling during insertion can touch the vessels, which will greatly “smear” the result of the examination. In addition, the occurrence of hematomas and bleeding is excluded.

Formations in the thyroid gland can be benign or malignant. Treatment will be prescribed based on their character, and erroneous treatment will cause incredible harm to the body and the consequences will be terrifying. The results of the study will dispel all doubts.

What kind of analysis is this?

Puncture of a thyroid nodule, although it sounds scary, is actually a very simple procedure and is not at all dangerous. What is a puncture? An incredibly thin needle is inserted into the node, which captures some of the tissue necessary for examination. It is tissue particles that can show what the patient’s problem is and what is necessary to improve the functioning of the thyroid gland.

To ensure accurate tissue sampling, the procedure is carried out under ultrasound control. The doctor observes the accuracy of the needle movement, and the puncture itself is made as close as possible to the sampling site. This eliminates any danger and the slightest likelihood of complications. If the formation is large (more than 1 cm), then there will be not one puncture, but several.

Many people are tormented by the question, is it painful to do a puncture? It all depends on your personal sensitivity threshold, but the puncture feels little different from taking blood from a vein. Unpleasant sensations occur only when the needle is inserted. There are no special recommendations before the puncture. The whole procedure will not take more than 40 minutes, regardless of the size of the node. The results of the thyroid puncture will be known in a few days.

Based on tissue examination, it will be known whether the formations in the thyroid gland are benign, malignant, or have an intermediate stage. In exceptional cases, fabrics may be uninformative. For the latter option, it will be necessary to carry out the entire procedure again in order to still understand the nature of the formation.

If the formation is benign, it is recommended to repeat the examination at least once a year. Malignant tumors are almost always treatable, so you should not despair of the diagnosis. It is recommended to remove it surgically, as well as formation in the intermediate stage. Surgery is the most reliable and effective method.

Indications for puncture

A puncture of the thyroid gland is necessary to clarify certain concerns, but an ultrasound examination still left gaps. This is the only analysis that allows you to study the structure of tissues. And he is appointed:

• In the presence of cystic formations on the thyroid gland;
• If malignant tumors are suspected;
• If nodules are detected on ultrasound;
• With ambiguous ultrasound images;
• When finding “suspicious” lumps and nodes by palpation;

Does puncture have contraindications? Yes. You cannot do the procedure if:

• The patient is very tiny;
• The patient has a blood clotting disorder;
• There are formations on the thyroid gland more than 3 centimeters;
• The subject was diagnosed with mental disorders;
• Repeated surgical interventions have already been performed;
• A woman has tumors in her mammary glands;
• The patient himself refused the examination.

If there is any suspicion of a formation, it is still advisable to perform a puncture of the thyroid gland. The analysis shown is recommended for a reason, and victory over any disease depends entirely on correct and timely treatment! You can neglect your health because of your own fears, but this is irrational.

Are there consequences?

After a puncture, any complications rarely occur if you trust a good diagnostician. So you should think carefully about where to do the analysis. The absence of complications will be due precisely to the professionalism of the diagnostician.

Infrequently, puncture of the thyroid gland provokes the following complications:

• The puncture site itself and the neck hurt;
• With osteochondrosis, you may feel dizzy when you rise suddenly;
• The cervical vertebrae may hurt;
• Sometimes minor hematomas appear at the puncture site.

There are no horrifying consequences from the procedure, and they cannot become a problem or provoke one. The common misconception that a violation of the integrity of a benign formation can provoke its transition to cancer has never been confirmed by doctors. The procedure is so simple that it does not even require anesthesia!

Conclusion

After the puncture, it will become known exactly what type of treatment the patient needs, and this is the most important stage of treatment. It is better to “panic” and do accurate tests on the nature of the formation than to skip the stage when the treatment is effective and the body does not weaken. Treatment of any disease is more effective and easier when the body does not need to maintain a level of vitality, and it is able to devote its strength to eliminating one specific threat.

Moreover, the early stages of malignant tumors can be treated with medication, but now late stages there is no way to remove it without the magic of a surgeon. Don't forget to support your body in the form of healthy image life, good nutrition and sports.

The thyroid gland is a small but very important organ for humans. Normally, it produces hormones that regulate metabolic processes in organism. In modern environmental conditions, changes and abnormalities of the thyroid gland are being diagnosed more and more often. In some cases, the nature of the neoplasms is unclear; they can be either benign or malignant. To exclude a cancerous tumor in the thyroid gland, patients are prescribed a biopsy. As a rule, there is no pain during the procedure, but sometimes (in exceptional cases) life-threatening complications occur after puncture.

In what cases is a puncture necessary?

Thyroid puncture is a manipulation performed under the control of ultrasound equipment. Its essence lies in the fact that a specialist inserts a regular sterile syringe with a small-diameter needle into the tumor to partially extract tissue, which is then examined in the laboratory. If the size of the tumor does not exceed 10 mm in diameter, one puncture is performed. A neoplasm with a large area requires several manipulations. One procedure takes no more than a quarter of an hour, of which the process of removing compaction tissue takes 3-4 minutes. Pain is possible, but quite tolerable. All manipulations with the needle are guided by ultrasound, since important blood vessels are located in this area. The slightest mistake can have very unpleasant consequences.

Carrying out such a study of the thyroid gland is recommended in the following cases:

• tumor size is more than 5 mm;
• presence of signs of cancer;
• the patient experiences pain when palpating the neck and nearby lymph nodes;
• cyst formation.

Before conducting the study, it is necessary to take a blood test (detailed).

Thyroid puncture is contraindicated:

• persons who have undergone several surgical operations;
• people with low blood clotting;
• patients with mental disorders;
• with a tumor size exceeding 35 mm.

In most cases, the manipulation is absolutely painless. Any mild pain that occurs can be easily eliminated by applying a small piece of cotton wool soaked in alcohol solution to the puncture site. Some patients complain that it hurts to turn their head after the procedure. This can be avoided by adopting the correct position during the doctor’s manipulations. To prevent dizziness, it is recommended to lie down for a while.

Most patients return home less than 24 hours after the biopsy, and some experience neck pain for several days.

What could be the consequences?

Like any therapeutic procedure, thyroid biopsy can have adverse effects. Problems are associated not only with the lack of professionalism of the specialist performing the biopsy, but also depend on physical health the patient and his individual characteristics.

The most common consequences are:

1. Formation of hematomas of varying degrees in the puncture area. The entire process of taking a puncture is carried out under the constant control of ultrasound sensors, which avoids injury to large vessels located in the neck. However, the structure of the circulatory system is different for each person, so it is almost impossible to avoid damage to the capillaries. This leads to bruising. Covering the wound with a cotton swab will help minimize the risk and reduce pain.
2. Slight increase in body temperature (up to 37 degrees). It happens quite rarely and lasts no more than a day. Absolutely safe for the patient's life.
3. Cough. This complication goes away without outside intervention after a few hours. Usually a cough begins when the node is close to the trachea. Sometimes it hurts a little to swallow.
4. The patient feels dizzy and may faint. Such symptoms are observed in people susceptible to osteochondrosis. cervical region and in very impressionable patients. The first is recommended to take a vertical position smoothly 10-20 minutes after the puncture. The latter can drink away the lungs sedatives within a week before the procedure.
5. Thyrotoxicosis. Symptoms of this psychological phenomenon include the appearance panic fear, sweaty palms, increased heart rate and anxiety. A doctor’s explanation of the safety of the procedure and a detailed answer to all questions will help to avoid this.

In some cases, complications arise that threaten the patient's life. They occur extremely rarely, but the patient should be under control for several hours medical workers.

Specialist intervention is necessary when the following symptoms are detected:

• profuse bleeding in the puncture area, which is difficult to stop;
• it is painful or almost impossible for the patient to swallow;
• fever up to 38 degrees or higher, accompanied by chills and fever;
• formation of a tumor of significant size in the puncture area;
• rapid and noticeable to the naked eye enlargement and pain in the lymph nodes;
• signs of infection.

A puncture of the thyroid gland is prescribed to determine an accurate diagnosis and choose the direction of further treatment. A gland biopsy can detect cancer in the early stages and save the patient’s life.

Please note that no specialist gives an absolute guarantee on the accuracy of the research results. The patient feels virtually no pain during this procedure. It is performed without anesthesia, takes little time and is safe in most cases. Negative reactions arise not only due to a violation of the manipulation technique, but also due to the physiological characteristics of the patient.

Often, if you have problems with the thyroid gland, it is necessary to undergo a procedure such as a puncture of the thyroid gland.

Another name for this examination method is fine-needle biopsy.

It is the puncture that allows you to find out whether the node is benign or malignant.

The final diagnosis and the effectiveness of the treatment that the doctor must prescribe depends on this information.

In what cases should the procedure be performed?

The formation of nodules in the thyroid gland is observed in many people, especially after the age of forty. However, this does not mean that every node poses a potential danger.

The number of malignant tumors among such patients occurs only in four to seven cases out of a hundred. A small nodule or several small nodules in the absence of symptoms most often does not pose a health hazard.

There are certain manifestations in which a specialist should be wary and order an analysis.
These include the following signs:

• a node or several nodes larger than a centimeter in size, which were discovered during a finger examination;
• cystic formations;
• nodes larger than 1 cm detected during ultrasound examination;
• discrepancy between the data obtained and the symptoms of the disease.

In addition, it is necessary to very carefully monitor the condition of the thyroid gland for certain factors that can provoke the onset of the disease.
These include:

• adolescence and childhood;
• exposure to ionizing radiation throughout the body or in the head and neck area;
• participation in the liquidation of a radiation disaster (for example, in Chernobyl);
• cases of malignant tumors in the thyroid gland in the patient’s relatives.

That is, the appearance of large nodules, especially with provoking factors, should be the reason for a thyroid puncture.

But first it will be necessary to carry out a series of tests to determine the level of thyroid hormones, an ultrasound examination of this organ. If there are significant changes, then the doctor will prescribe a puncture of the thyroid gland.

If the nodes increase in diameter to 8-12 mm over six months or a year, a biopsy must be done.

Why are nodes in this organ dangerous?

Every forty man and every fifteenth woman have small nodules in the thyroid gland. Moreover, the older a person is, the greater the likelihood of nodes occurring. Why are they dangerous?

First of all, they grow, which means they interfere with the organs that are located next to the thyroid gland. That is, they compress the trachea, esophagus, and nerves located near the thyroid gland.

As a result of such transformations, following symptoms, which constantly appear and bother:

• difficulty breathing;
• problems swallowing;
• feeling of a lump in the throat;
• drowsiness;
• weakness;
• excessive fatigue;
• difficulty pronouncing words;
• mood swings;
• a sharp jump in weight - increase or decrease;
• increased sweating.

The cause of the appearance of nodes may be a lack of iodine that enters the body. It is necessary for the normal production of thyroid hormones. If there is not enough of it, the production of hormones decreases.

At the same time, the thyroid gland tries to compensate for the lack of hormones and takes iodine from the blood. An important organ works very actively, and a goiter occurs. But not all glands work so actively. In some areas, vasodilation occurs, this leads to tissue density, and a knot is formed.

In addition to a lack of iodine, poor ecology, radiation, and hereditary predisposition also lead to the formation of nodules. That is, the occurrence of this pathology can be influenced by various factors.

Even frequent stress and regular hypothermia can give rise to improper functioning of the thyroid gland and, in particular, to the formation of a node or nodes.

If the nodule is small and at the same time thyroid functions normally, produces the required number necessary hormones, it is not dangerous to health. You just need to observe the patient.

If there are many nodes or they grow, the thyroid gland may not work properly, hormones are produced in too large or very small quantities, naturally, this leads to various diseases. And the most dangerous thing is thyroid cancer. Therefore, puncture of the nodes is necessary.

Thyroid puncture is the most informative procedure that helps to accurately determine the presence of oncology.

How does this manipulation work?

Thyroid puncture is not very complicated diagnostic procedure, if performed by a qualified and experienced doctor.

The essence of the procedure is to insert the syringe needle into the gland node and draw its contents into the syringe through the needle. After this, the material is sent for research, which will determine which cells are contained in the node. And determine whether the node is dangerous or not.

There is no need to prepare for this manipulation. No special exercises or diet are needed. Experts only recommend not to eat more than usual on the eve of the procedure.

But psychological preparation may be needed. If the patient is afraid of the procedure, the doctor should tell about the upcoming procedure in more detail and reassure the patient. You can also read articles and reviews on this topic.

Here's how the procedure goes:

1. The patient should lie on the couch with a pillow under his head.
2. The specialist finds the node by palpation.
3. The patient must swallow saliva as many times as the doctor tells.
4. The doctor inserts a needle (it is very thin) into the thyroid node.
5. He draws the contents of the node into the syringe.
6. The specialist removes the needle and applies the material to the glass.
7. The doctor seals the puncture site.

Usually the specialist makes not one, but several injections in different parts of the node. This helps to get material from different places, it is more informative. The procedure is carried out under the control of an ultrasound machine, as it requires precision.

The needle used is very thin and long, this avoids the formation of a hematoma or bleeding, because the thyroid gland is an organ with a very developed blood supply system.

After the procedure, within ten minutes, the patient can go home. You can play sports or take a shower only a few hours after the puncture.

The preparation and procedure lasts about twenty minutes, and the biopsy itself takes about five minutes.

Patients are usually worried about the question: does it hurt to do a puncture? No anesthesia is required for this manipulation; the sensations are the same as with any regular injection.

What are the consequences of thyroid puncture?

This procedure is usually well tolerated. Possible consequences are minimal if the puncture is performed by a highly qualified specialist.
However, the following unpleasant consequences may occur:

• hematoma formation;
• dizziness after the procedure;
• temperature rise to 37 degrees;
• symptoms of thyrotoxicosis;
• appearance of cough;
• laryngospasm;
• nerve damage in the larynx.

As for hematoma, although monitoring with an ultrasound diagnostic device helps to avoid damage to large vessels, it is almost impossible not to damage small capillaries and vessels.

It is in order to avoid such consequences that a thin needle is used, since larger diameter needles touch more vessels and capillaries.

Dizziness may occur if there is cervical osteochondrosis. Very impressionable patients are also susceptible to this.

To avoid this problem, you should get up from the couch after this manipulation carefully, slowly and smoothly. It is advisable to lie down for 15 minutes before getting up.

A sudden rise can cause dizziness. The patient must be warned in advance about this feature.

Body temperature rises quite rarely. It can rise in the evening of the day when the thyroid nodule was punctured.

The temperature can rise to thirty-seven degrees or slightly higher. This increase does not pose any serious danger. However, if the temperature persists the next day, it is better to consult a specialist.

Tachycardia, sweating of the palms, severe psychological discomfort - all this can arise due to strong fear of complex manipulation. That is, symptoms of thyrotoxicosis will appear.

You should not pay attention to them, they are not a manifestation of the disease. The specialist must first talk with the patient, help him overcome his fear and properly tune in to the procedure.

Coughing after the procedure may occur if the thyroid nodule is close to the trachea. This cough is usually short-lived and goes away without additional help very a short time.

In extremely rare cases it may be damaged laryngeal nerve or laryngospasm may begin. In such cases, the specialist will take all necessary measures to get rid of such undesirable consequences.

What complications can occur after a thyroid biopsy?

Although this procedure is not too complicated, if it is performed by an insufficiently experienced specialist, some complications are possible. If they appear, you should immediately consult a doctor.
These include:

• trachea puncture;
• infection in the thyroid nodule;
• heavy bleeding;
• significant swelling at the puncture site;
• high fever;
• swallowing dysfunction.

A puncture of the trachea can lead to a coughing fit. To stop it, the specialist must remove the needle. The procedure will need to be rescheduled for another time.

This can happen due to the inexperience of the doctor or improper behavior of the patient (if he does not remain completely still). To avoid such a complication, it is necessary to strictly follow the specialist’s instructions and not move during the manipulation.

If the syringe for taking a puncture is not properly sterilized, infection may occur. This leads to swelling, pain, redness, and inflammation at the puncture site.

In this case, you must immediately contact a specialist, he will immediately begin treatment. It is easier to remove inflammation if it is just beginning. And if the treatment process is delayed, serious health problems are possible.

If severe bleeding occurs in the puncture area, this means that the doctor has hit a large blood vessel with the needle. Usually this complication occurs immediately during the procedure.

Therefore, the doctor will immediately take the necessary measures. Of course, bleeding is a rare complication, because thyroid puncture procedures are carried out under the control of an ultrasound machine.

Severe fever may occur due to infection. Therefore, if the day after the biopsy procedure this problem is still bothering you, you should immediately seek help from a specialist.

As for the dysfunction of swallowing, there may be only mild discomfort, which can be easily eliminated with special lozenges. If discomfort persists, only a doctor can help.

It is better to place your head on a high pillow while sleeping. This will have a positive effect on the healing process. But it is not recommended to sit for a long time, otherwise the puncture area may become deformed.

What else may bother you after the puncture?
The following unpleasant symptoms may appear:

• nausea;
• vomit;
• dizziness;
• weakness and loss of strength.

But in general, all these signs pass quickly and do not bother you after a couple of days. The wound heals in three to four days, it may itch a little, which indicates tissue healing, this is absolutely normal.

Contraindications for this procedure

Not everyone and not always can carry out this manipulation. Puncture of the thyroid nodule has no direct contraindications.
However, in practice, the procedure is not performed for the following pathologies:

• mental illness;
• impaired blood clotting;
• patient refusal;
• a certain age;
• tumors of the mammary glands;
• numerous operations performed;
• node size more than 3.5 cm;
• diseases with impaired permeability of the vascular wall.

Naturally, in case of bleeding disorders, it is problematic to carry out such a procedure, as well as other similar manipulations, because severe bleeding may occur.

If the patient is Small child, then the procedure can only be done with the use of anesthesia, and this is also not always possible.

In addition, if there is arrhythmia, tachycardia or hypertensive crisis on the day of the biopsy, the manipulation can be postponed or carried out only after permission from a specialist.

Results of thyroid puncture

Study results may vary.
Based on the content analysis, a conclusion is made about the nature of the node, it can be:

• malignant (oncology);
• benign.

The result can also be intermediate (uninformative).

Naturally, if the result is uninformative, you will have to carry out reanalysis- do a puncture. And if the result provided all the necessary information, additional research no thyroid needed.

A benign result usually indicates the development of nodular goiter and various types of thyroiditis. Naturally, the main tactic is to monitor the patient’s health status.

If the node is colloidal, then most often it does not develop into cancer. That is, it is necessary to regularly take tests for thyroid hormones and be examined by an endocrinologist. At least once a year.

The intermediate result is follicular neoplasia. Most often, it is a benign formation, but it can also be malignant.

With this result, this organ is usually removed, and the material is sent for histological examination. You will need to take thyroid hormones to prevent hypothyroidism from developing.

In 85% of cases, the colloid nodule is benign and does not develop into cancer.

The malignant result is thyroid cancer. Naturally, in this case, removal of part or all of the thyroid gland is required. It all depends on the specific type of neoplasm, as well as on the tests and decision of the specialist.

But in any case, surgical intervention is necessary. After surgery, it is usually prescribed replacement therapy, that is, the patient must take certain hormones so that the quality of life does not deteriorate.

Thyroid puncture is a simple procedure, but it must be performed by a highly qualified and very experienced specialist.

After all, it must be carried out very precisely, the slightest violation of the rules of conduct, and serious complications are possible. In addition, the reliability of the analysis results depends on the correctness of the procedure.

In any case, if there are indications, the procedure must be carried out, and then follow the doctor’s instructions. This will help avoid serious health problems.

Ask an expert a question in the comments

Thyroid puncture is a simple procedure consisting of puncture of the nodules of this organ in order to assess the risk of its malignancy. This is a fundamental test because it provides a lot of information with virtually no risk of complications.

How the procedure works

Puncture of the thyroid gland is usually done using an “eco-oriented” method - guiding the needle with ultrasound to ensure that the organ is punctured only in the right place.

If you have problems with the thyroid gland, you need medical advice. When should such a procedure be carried out? Each case will be studied individually. The main tests to perform are:

• ultrasound;
• hormonal analysis;
• clinical examination.

If based on these data there are suspicions that the nodule may be malignant, then a puncture of the thyroid gland is performed. The most important factors when determining whether a nodule is suspicious and, therefore, taking a puncture, are determining the size and appearance organ on ultrasound.

When is a puncture necessary?

In general, nodules smaller than ten millimeters will not be punctured unless risk factors are observed on ultrasound (eg, “irregular borders” or microcalcifications).

Reviews of thyroid punctures report that large nodules (greater than 15-20 mm in size) almost always need to be punctured unless ultrasound shows they are purely cysts (fluid sacs). In this case, a puncture may be done to reduce the size of the nodule. But there will be very little analysis since only solid material, not liquid, can be analyzed.

It should be borne in mind that thyroid nodules are very common problems, the vast majority of them are determined to be benign. Therefore, the mission of the endocrinologist is, on the one hand, to detect suspicious nodules in order to puncture them, and on the other, to avoid puncture of nodal areas with a very low probability of being malignant.

Preparation for the procedure

Ultrasound-guided puncture of the thyroid gland requires careful preparation. A preliminary analysis is necessary, mainly for two reasons. First look at thyroid hormones, coagulation and make sure there is no risk of bleeding. The patient must be accompanied. Some sensitive people may feel dizzy immediately after getting a piercing, although symptoms usually disappear within a short time.

Medicines that may interfere

It is very important to tell your doctor about all the medications you take regularly and if you have any allergies to medications or other foods.

It is necessary to stop taking anticoagulants (“medicines to make the blood thinner”) such as:

• "Acenocoumarol";
• "Warfarin";
• "Dabigatran";
• "Rivaroxaban";
• "Apixaban".

You should avoid aspirin, ibuprofen and other anti-inflammatory drugs in the week before your test. There is no need to take any additional medications.

Food

There is no need to follow a special diet, although some centers recommend not eating for about eight hours before the test. As a rule, it will be enough not to eat breakfast or drink anything before having a thyroid puncture.

Cloth

It is advisable to wear clothes that have a wide neck or can be easily opened (such as a button-down shirt) to free up the thyroid area. Avoid wearing necklaces or other jewelry around your neck.

Pregnancy and lactation

Thyroid puncture is not contraindicated during pregnancy or breastfeeding, but you will need to inform health care providers if you are pregnant or suspect you are pregnant. Some hormones change naturally during these stages, which can affect your analytics.

How is the procedure done?

If the nodule is alive, then puncture may be impossible. In some cases, nodules in chest may be checked by puncture, CT-guided, or may require exploratory surgery.

A puncture of the thyroid gland under the supervision of specialists lasts approximately 15-20 minutes. Obtaining the biopsy itself occurs very quickly, the rest of the time consists of preparing the material and the area to be biopsied.

The thyroid gland is performed with the patient lying supine in a position that leaves the thyroid gland exposed. Sometimes a pillow is placed under the shoulders to relieve hyperextension of the neck. After the patient has taken horizontal position, a local antiseptic will be injected, and the doctor will find the node that will be punctured using ultrasound.

The puncture is performed with a very thin needle, which must reach the thyroid gland (usually thinner than the thyroid gland). With the needle in the knot, gentle movements will be made to aspirate the material to ensure that the tissue is removed, then the needle will be removed. During this part of the procedure, the doctor warns the patient to try not to cough, swallow, or speak: when the thyroid gland moves, it will be more difficult to diagnose.

Typically, two to six punctures are required, depending on the quality of the resulting sample. Thus, the entire size of the nodule is covered, and more accurate diagnosis is more likely.

If it is a cystic nodule, it can be emptied with a syringe to reduce the size and relieve discomfort. Once the piercing is complete, you will be asked to press on the pierced area for a few minutes. After a thyroid puncture, feelings of dizziness may be present. Since it does not require anesthesia or sedation, after a few minutes of recovery you can return home without any problems.

What are the complications and risks?

A puncture of the thyroid gland, according to reviews, can have consequences. The main complication is that there is slight pain at the puncture site. It can be treated with regular pain relief and/or topical ice application.

Dizziness may occur during or immediately after the procedure in susceptible individuals. What happens to the material obtained after the procedure? Part of the material is spread over several slides (a glass plate for viewing under a microscope), and the other part is stored in a special solution for further preparation for the microscope.

After processing the samples, the doctor will be able to determine the diagnosis. How long does it take for results to last? This depends on the center where you were tested, but usually from two to three days to two to three weeks. What are possible results: Each center or institution can use different classifications, but the most commonly used nowadays is the so-called 6-category system.

It should be taken into account that puncture of the thyroid gland with ultrasound does not analyze tissue blocks (biopsy), but only individual cells (cytology). Thus, this is an indicative test that only indicates the risk of malignancy, but the final diagnosis will always be made by biopsy with surgery.

Review of results

The consequences of thyroid puncture will be presented in the form of the following results:

Is it possible to get a benign result or is the node really malignant? Although rare (1-2%), a malignant nodule can lead to benign tumor thyroid gland. This small risk is inevitable, so it is very important to plan adequate surveillance, which allows specialists in the field of endocrinology to monitor the process. If changes in evolutionary control that suggest malignancy are observed (eg, growth greater than 20%), a second stage or, if necessary, surgery may be performed.

If the nodule is malignant, the usual treatment is applied, although a little later. Fortunately, in these cases the results are almost as good. Current recommendations from the Thyroid Association (ATA) focus on planning surveillance according to ultrasound characteristics and puncture results.

What genetic tests are used?

IN last years Genetic techniques have been developed to help determine whether a nodule is benign or malignant. These methods examine multiple node genes in the material extracted from the puncture. Today they are not performed regularly, but are usually used when the result of the puncture is uncertain.

It should be borne in mind that a genetic diagnosis is also not final, but will help determine the decision. It can be performed on the first piercing or reserved for a second piercing when in doubt.

Let's sum it up

Endocrinologists believe that one of the main reasons for the appearance of nodes is the lack of iodine. This element is necessary for hormone synthesis; if the body delivers it in insufficient quantities, the organ begins to work intensively and grows in size. Excessive activity of the thyroid gland can lead to the formation of endemic goiter.

Other causes of nodule formation may be radiation, hereditary diseases, bad environment. If the size of the tumors is more than 3 centimeters, there may be a number of dangerous symptoms: hoarseness, shortness of breath and a constant feeling of a lump in the throat. In such cases, in order to examine the tumor and eliminate the risk of developing cancer, a puncture of the thyroid nodule is performed.

To do this, the doctor makes a sample. To increase the accuracy of the procedure, ultrasound scanning is performed. Is thyroid puncture performed on everyone? A biopsy may be performed on a patient with a small, isolated lump if they have a history of exposure, have a family history of cancer, or have an ultrasound showing the presence of a tumor.

The article is devoted to one of the most effective examinations of various thyroid tumors - fine-needle aspiration biopsy. It contains information about the instruments used for this manipulation, the course of the procedure, indications and contraindications for it.

The result of thyroid puncture is discussed in particular detail with interesting photo materials and videos in this article.

The thyroid gland (glandula thyreoide) is a small organ of the endocrine system located in front and on the sides of the trachea. In a normal state, it is practically undetectable during palpation examination.

Among the pathologies of other endocrine glands, diseases of glandula thyreoide are the most common. The situation is complicated by the fact that such diseases can occur in a hidden or latent form.

And often the only sign that will indicate to the patient that not everything is in order with his thyroid gland is an enlargement of this organ. And the most accurate way to find out exactly what caused this phenomenon is to use a fine-needle aspiration biopsy (FNA).

Unfortunately, one of the most dangerous diseases of the thyroid gland, nodular neoplasms, is becoming increasingly common. Among women over fifty years of age, the incidence of nodes reaches 50% of the population. With increasing age, this figure only increases.

As for the malignant degeneration of these neoplasms, it occurs in 5–6% of cases.

Medical tactics no longer provide for complete cleansing of the gland tissue from pathological formations, but focuses on accurate diagnosis and combating only those that have entered the process of degeneration or have grown so large that they have begun to pose a threat to the functioning of surrounding organs. And this is where a puncture of the thyroid gland comes in handy, the research results obtained from which will help determine which node should be urgently removed and which one can be left alone for now.

Indications for TAB

Aspiration biopsy is mandatory in the presence of the following neoplasms:

• cystic;
• anyone whose symptoms indicate a malignant course;
• nodular, having a diameter of 10 millimeters or more, detected using ultrasound or manual examination;
• nodular, identified during or palpation examination with signs of malignant degeneration, less than 10 mm in size.

Table: Indications for thyroid puncture:

In these cases, you should not delay the study, because not only the health, but also the very life of the patients is at risk.

What determines the price of a thyroid node biopsy? The cost of a diagnostic puncture is exactly the same: 3000-6000 rubles.

This cost variation is formed as follows:

1. biopsy “with” or “without” ultrasound guidance;
2. how many formations need to be punctured;
3. methods of cytological research;
4. urgency of the procedure and results.

Cytological examination of a suspension of cellular material is lower in diagnostic efficiency than histological examination of thyroid tissue. In some cases (this is rare), the material obtained for microscopic examination may be of poor quality, that is, it may contain fragments of cells and serous fluid, which is not a sufficient argument for surgical resection of the affected part of the organ.

A piece of tissue taken for research contains a number of cells from which the structure and nature of the pathology can be determined. It is this analysis that is an indication for surgical intervention.

Progress of the study

The peculiarity of this technique is the collection of biological material for further research using a needle of a particularly small diameter, which is why it is called fine-needle aspiration biopsy.

Advantages of FNA over other methods for examining thyroid nodules:

• Easy diagnostics. The medical instructions for this diagnostic method indicate the absence of special sophisticated equipment for the study. The duration of the manipulation itself is 2-5 seconds.
• Low price of the procedure. The cost of a puncture biopsy is slightly higher than the cost of an ultrasound examination of the thyroid gland.
• Almost complete absence of contraindications and complications.
• Absolute reliability of survey results. This is the only method for establishing a definitive diagnosis.

Material collection can be performed using two control methods:

• palpation;
• ultrasonic

Currently, doctors have almost completely abandoned the use of the first method, due to its low accuracy, and use ultrasound equipment in their practice.

Consumables

For this manipulation, disposable syringes are used, ten or twenty cc with needles having a diameter of 23G and below, up to 21G.

Important! The thinner the needle used for puncture, the less pronounced the pain from the puncture and the less blood from the injured gland tissue gets into the puncture.

Anesthesia

Standard instructions for performing TAB do not provide for anesthesia, since the duration of the manipulation, if performed by an experienced doctor, does not exceed 2–5 seconds, and the diameter of the needle is so small that its insertion practically does not cause pain.

Important! Carrying out anesthesia, both general and local injection, during TAB does not make sense also because the pain during parenteral administration of the anesthetic exceeds that during the puncture itself. Plus, possible complications from pain relief make it much riskier than the collection of biological material itself.

The only justified method of anesthesia is the use of anesthetic creams with prilocaine, xylocaine or lidocaine in the form of sprays or creams applied to the skin 60 minutes before the procedure.

The total duration of TAB is up to a quarter of an hour, but the vast majority of time is spent filling out written and electronic documentation:

Examination stage	Manipulations performed
	Patient registration, explanation of the FNA technique
	Giving the patient a comfortable position - lying on the treatment table, with the ability to adjust the angle of inclination and height with a small pillow under the back, which allows for sufficient extension of the neck. Treating the surgical field with an antiseptic and separating it from the surrounding skin surface using a sterile napkin. Ultrasound examination of the gland and the puncture itself under the control of ultrasound equipment.
	No special manipulations are required at this stage, except for manually fixing a sterile cotton ball at the skin puncture site for five minutes and you can safely go home.

The main requirement for all stages of TAB is compliance with sterility standards, which will be discussed in more detail in the next paragraph.

Sterility during FNA

In order to prevent the patient undergoing examination from becoming infected with all kinds of blood infections, such as HIV or hepatitis B, all stages must be carried out in strict accordance with the requirements of the sanitary-epidemiological regime.

The most problematic item in this regard is the ultrasonic sensor, the complete disinfection and sterilization of which is quite problematic. Most often, the destruction of pathogenic microorganisms that have reached it is carried out by immersing the sensor in a disinfectant solution, which does not guarantee one hundred percent destruction of pathogens. Therefore, the further a patient is in the queue for TAB, the higher his chance of getting an infection from one or even several previous patients.

The likelihood of nosocomial infection is even higher if puncture attachments are used on an ultrasound sensor, through which a puncture needle is passed in order to increase the accuracy of hitting the node. However, during the reverse stroke of the needle, biological fluids from the surface of the needle remain inside the puncture nozzle, and removing them from there is very problematic.

The only method suitable for this purpose is autoclaving, which is very rarely used in medical centers.

Therefore, to undergo FNA, you should only contact those medical institutions that practice biopsy using the “free-hand” technique. The essence of the method is to protect the ultrasound sensor using a disposable sterile cover, worn and disposed of in the presence of the patient.

In this case, the doctor does not use guides for the puncture needle, holding it in one hand and the sensor in the other. An experienced specialist with developed skills and under such conditions will easily get to the desired node, while reducing to zero the likelihood of nosocomial infection of the patient.

Frequency of procedure

Answering the question of how often a puncture of the thyroid gland can be done - usually the procedure should be performed once in order to minimize damage to the organ tissue. However, there are exceptions. If a benign node was diagnosed for the first time, but over time it quickly increased in size (which is not a prognostically favorable sign), a repeat fine-needle aspiration biopsy is performed to identify the cause of the accelerated growth and exclude its malignancy.

Statistical data states that the uninformativeness of a biopsy ranges from 5 to 25%, i.e. the answer obtained as a result of FNA of the thyroid gland does not give a clear answer to the question “Is the identified nodule malignant?” This situation also requires a repeat procedure at least 1 month after the initial puncture. If 3 procedures were uninformative, patients are usually advised to undergo surgery to remove the node.

The consultation is usually carried out by an endocrinologist surgeon - a specialist involved in these procedures. Before TAB, he necessarily examines the patient and additionally explains how the thyroid puncture is done.

Complications of TAB

There are no contraindications to this type of research. During its implementation, the following complications are possible:

1. Phlebitis of veins.
2. Trachea puncture.
3. Infection of the puncture site.
4. Injury to the nerves located in the larynx.

All these complications can develop due to the low qualifications of the specialist performing the procedure, and they practically never occur among experienced doctors.

Reading the result

The formulation of the research result may look like this:

• intermediate result;
• uninformative result requiring repetition of the study;
• benign course (if a colloid node is detected, further observation is required to exclude degeneration into cancer);
• malignant course (cancer), requires urgent surgical intervention with further treatment of postoperative hypothyroidism.

An informative result does not require repeating the biopsy; it is used to choose medical tactics. If the result is benign, annual monitoring of the development of the tumor is required, and only if rapid growth is observed (more than 10 mm per year), repeat TAB is performed.

Information content of the procedure

The doctor expects a specific result from TAB, whether the neoplasm has a benign or malignant course. However, the proportion of uninformative results requiring repetition of the procedure is quite high (4 – 30%). In case of repeated uninformative results, as a rule, surgery is performed to exclude glandula thyreoideae cancer.

How to increase the information content of the TAB?

A number of medical centers, in order to increase the effectiveness of research, practice simultaneous collection of punctate from several nodes (2 – 6), which, naturally, makes the procedure much more painful.

Leading centers strive to improve the quality of TAB in the following ways:

1. Staining of preparations according to international protocols, creating the best conditions for their analysis.
2. Use up to 6 glasses for cytological smears in order to preserve the material and increase the accuracy of the research.
3. Manipulations are carried out only by the most experienced specialists with experience in performing at least 10,000 biopsies, with regular performance of 300 manipulations per week.
4. Performing a puncture according to the rule: one node, one injection, but at the same time collecting cellular material from different areas of the neoplasm, resorting to repeated injections only in the case of an excessively high density of the node.

Thanks to such innovations, the likelihood of obtaining informative results in leading medical centers has increased to 92%, exceeding the European average.

Interpretation of the result

Only an experienced cytologist specializing in the study of the thyroid gland can make an accurate conclusion on the drug, since the criteria for studying this gland differ from those for other organs.

The obtained biological materials are classified as follows:

1. Suspicion of a malignant course with an inaccurate result.
2. Malignant degeneration of a tumor-like neoplasm.
3. Obtained from a node whose development process proceeds benignly.
4. Not suitable for research or provided in insufficient quantities.
5. Cellular material with atypical or follicular changes, the genesis of which is not clear.
6. Follicular cells that synthesize thyroid hormones involved in tumor processes.

If it is possible to thoroughly study the biopsy, the cytologist will be able to make an accurate diagnosis.

Thyroid cysts

With the help of TAB, it is possible not only to determine its type.

Signs of various types of cysts are given in the table below:

FNA for cysts, both single and multiple, acts not only as a diagnostic, but also as a therapeutic procedure, facilitating aspiration of pathological contents.

Hashimoto's thyroiditis

This disease is a chronic inflammation of glandula thyreoideae tissues, which is autoimmune in nature (read more). The pathology may be accompanied by the formation of nodular structures, which are examined using FNA.

The cytological picture of the disease is characterized by:

1. Infiltration of lymphocytes.
2. Atrophy of tissue parenchyma.
3. Fibrous tissue changes.
4. Development of eosinophilic changes in acinar cells.

FNA for this pathology is necessarily supplemented with a biochemical blood test.

Benign neoplasms

The cytology of benignly developing nodes is practically indistinguishable from normal. In this case, the cytologist can formulate a description as follows. The appearance of such a neoplasm can be triggered by increased growth of individual parts of the thyroid gland, in which the structural units of the gland, thyroid glands, grow in size and turn into an adenoma.

The colloid node may undergo malignant or cystic (cystadenoma) degeneration.

Thyroid cancer

In this case, FNA helps to identify a malignant tumor and determine its type. Up to 90% of cases of malignant degeneration of the gland occur in.

Its cytological picture is characterized by:

1. Multinucleation of cells.
2. Sticky colloid consistency.
3. The appearance of round cell nuclei.
4. Metaplasia of squamous elements.
5. Weakly expressed cellular polymorphism.
6. The formation of various kinds of pathological cellular structures.

Another type of malignant degeneration, follicular cancer, accounts for up to 15% of cases.

A biopsy of this pathology is characterized by:

1. Lack of colloid.
2. An increase in the size of cell nuclei.
3. Overlay of cellular elements on top of each other.
4. The appearance of nuclei shaped like a circle or oval.

Degeneration in the form of medullary cancer is rare. Its cytology is characterized by:

1. Polygonal shape of cells.
2. The presence of several nuclei within one cell.
3. Polymorphism, expressed to varying degrees.
4. Disjointed arrangement of cellular elements.
5. The production of calcitonin in neoplasm cells.

Anaplastic cancer is even less common. Its feature is uncontrolled cell growth.

An extremely rare form of malignant neoplasms is insular cancer, the basis for the formation of which is the follicular epithelium. In this case, the biopsy contains cellular elements whose structure is similar to follicles, but their size and shape are varied.

Cytology for any type of malignant degeneration allows:

1. Perform initial detection of malignancy.
2. Track all changes in the cellular structure of the gland.
3. If treatment is successfully completed, confirm recovery.

The use of FNA is not often used, only in cases where it is necessary to visually assess the cellular structure of glandula thyreoideae; the cost of the procedure is small compared to the benefits it brings.

Puncture of the thyroid gland and the research results obtained with its help make it possible to determine the pathology in 95% of cases, and moreover, this can be done at the very early stages. Which, in turn, allows you to select medical tactics in a timely manner and, with the least losses, defeat the pathology.