FNA for Diminution of lymph node

[Winkle214]

Hello,
I had total thyroidectomy for pap.cancer in 1995,(unencapsulated)  followed by I-131 radiation. Have had no problems to speak of since. My doctor has been doing US to follow a few suspicious lymph nodes for last 3 years, This year he said there is diminution of lymph nodes and he wants to do FNA. Isn't 'diminution' a good thing? Has anyone heard of this? Doc said the fatty tissue within seems to be shrinking.( ??). My TG remains very low, as always. Other than blood work and US, I have no other follow-up tests. ( Is it beneficial to have a chest xray?)

The US report said, " the 2 lymph nodes are seen lacking fatty hila "..one had increased in size and one is new since last year.

Any feedback would be appreciated.
Thanks!

[Mark Lupo, M.D.]

Not sure what he means by dimunition....but the loss of the central fatty hilum is sometimes a concerning feature seen on US, and FNA can help determine if this may be a suspicious node (make sure the FNA is sent for cytology AND Tg-washout).  In the absence of increasing serum TG, there is not likely a need for routine CXR.

[Mark Lupo, M.D.]

The Iowa folks may want to read updated articles on lymph node FNA w/ Tg washout (at the same time).

Hopefully your testing comes out straightforward to help guide treatment/follow-up.

http://www.thyroid.org/professionals/publications/guidelines.html
--- cut/paste this link, click on nodule & cancer 2009 - page 11 addresses this issue of Tg washout (may be helpful for future patients).

[Winkle214]

I had my FNA this afternoon. It was guided by US, and the pathologist were in the room. I inquired about TG Washout and the resident US person said once they determine if there is a problem with my l-nodes, they could schedule more tests. I explained that TG Washout should be done with this procedure and she referred me to the pathologist's in the room. The pathogist said they really don't do that- his explanation was that if the node is benign it is not needed, and if the node is not benign, they take it out. I explained that TG Washout would aid in the diagnosis - but he didn't think it was ever necessary. I was kind of disappointed.

BTW, this is at a large teaching hospital in Iowa.

Any suggestions on how I could encourage this in the future. ( If these test are benign, I have another FNA in 6 months.)

Thanks in advance!

[Winkle214]

Thank You Doctor. My FNA is scheduled for this afternoon. I will ask about the TG Washout. Thanks for responding!