FNAB's

[mark80]

How many fine needle aspiration biopsies are needed before a diagnosis for papillary thyroid cancer can be made?  I am a 54 year old male and was exposed to radiation therapy for acne over 30 years ago.  Ultrasound shows nodules with either vascularity or microcalcification.  Some nodules are over 1 cm.  I have had 2 sessions of FNAB for a total of 6 needles going in.  The first results were inconclusive and the second ones only revealed blood.  I am scheduled for a 3rd session in November 2008, which will make it a year since the first FNAB.  Is this a normal time frame?  Are the results always so elusive?  Thanks.          

[dscoochie]

Hi Mark,

I live in Canada too (Toronto) and I understand your concerns regarding wait times.  It amazes me when my friends in the USA get ultrasounds, biopsies, and surgeries within a few weeks of each other!!!

Being treated with the watchful waiting theory is not uncommon.  "Lets keep an eye on it, retest it in a few months, see what happens then"...I heard that too.

However, I didnt want to wait.  I wanted it out.  My biopsy came back inconclusive (which seems to happen VERY often, as a biopsy takes a tiny sample of what the nodule is) and I was told a 15% chance of cancer.  With those chances, it was suggested that I retest (biopsy) in another 6 months, but I opted for surgery.  It was cancer, and I had a completion surgery two months later (just a few weeks ago).  

Do not doubt your care at McGill.  Definitely one of the best hospitals around!  However, YOU have to be proactive in your health care.  If you are okay with restesting in six months, fine. If you want to see a surgeon and discuss your options - then get that ball rolling.  If you want to see an Endo, ask to be referred to one for a second, third fourth opinion.  Your health care is in your hands.

All the best to you,

D

[mark80]

I live in Montreal, Canada.  I am being treated at the Montreal General Hospital, part of the McGill University Health Centre.  Here are some statistics:

The McGill University Health Centre at a Glance
Each year, the MUHC receives over 802,000 ambulatory visits, including 134,000 emergency department visits
The MUHC receives 37,000 inpatients yearly
The Research Institute of the MUHC is the largest medical and life sciences research facility of its kind in Canada and obtains close to $100 million in research funding annually from external sources
More than 11,500 healthcare and other personnel work at the MUHC
Anually there are:

29,847 surgeries
667,910 ambulatory visits
134,580 Emergency Department visits
3,100 Births
8,884,102 Diagnostic tests

In Canada we have a "socialized" medical system.  Equal access to all, paid for through income taxes.  I don't know where else I could go.  It would cost me a personal fortune to pursue anything south of the border, and it would not be covered (reimbursement) by our health care program.

Mark

[ChitChatNine]

Mine were FNA atypical and came back after surgery totally benign BUT they found, as above poster, two small papillary micro's elsewhere in the gland that neve showed up on any test.

But to ease you after I posted the above, I still have a small nodule in my intact side that I watch and wait .. it is only 4.0mm large and looks just like the benign ones removed 1/07 which were almost 2.0cm's.  So watch and wait is fine if A) you are ok doing so and B) they think it isn't cancer .. but on the flip side ...... it could be cancer and they are taking too much time waiting for repeat FNA's.

Can you travel further distance someplace else to larger hospital to have your next FNA done?

C~

[4lynnie]

I have had 3 FNAs, one each for the last 3 years, due to a cold nodule and enlarged thyroid since the 1960s altho I never had radiation treatment for acne/thyroid/anything as a youth.   The results always OK.   I've also had two uptake scans, both showing one, cold nodule.   January, 2008 there was a second nodule, and GP sent me to ENT who did ultrasound (here I thought uptake scans were more definitive)....and there were 16 nodules.   ENT said we could biopsy all or remove gland.   Gland was removed February, 2008:  all nodules were OK, but two spots of papillary cancer on back of gland.   Shows nothing is definitive

[mark80]

The ultrasound and calcification along with the other indicators (not to mention the history of radiation exposure) raise suspicion that the nodules could well be papillary carcinoma.  The doctor's approach seems to be one of waiting 6 months before another ultrasound guided FNAB is performed.  This will show what growth or change has taken place.  The hospital is waiting for a new ultrasound machine but it is not known when it will be in service.  I understand that the skill of the personnel doing the FNAB as well as lab work can be a factor for the quality of the results.  Surgery, if necessary, would be done within 6 months of a confirmed diagnosis, perhaps earlier depending on urgency of the case and availability of the surgeon.        

[ChitChatNine]

Geez, so sorry this is so long and drawn out .. I guess I'd be concerned with some of the features on the ultrasound report but I'm not a Dr. of course.  Definitely check out the success rate of the facility you are going to .. yes, there are different rates of success and /or accuracy of FNA's .. this I learned from my own Dr. who sent me miles away to a better facility.

I feel bad for you .... inconclusive results are tough on the wait and see roller coaster.  

What did your Dr. say originally based on the ultrasound and the calification ?

Cheryl

[898]

If nodule is solid, and FNA results are inconclusive, core biopsy may give better results; if nodule is mixed or complex, the high resolution ultrasound guiding must be used with FNA; I am not sure about the time frame but I would consider to have someone experienced to do FNA next time.