Other 

Thyroid formation tab. What is Fine Needle Aspiration Biopsy - Thyroid TAB? Possible side effects

Formations in the thyroid gland are often found by chance: a person notices a swelling in the lower part of the neck, sometimes a doctor finds a pathology during examination or undergoing a preventive ultrasound.

If a neoplasm larger than 10 mm is found, it is required additional diagnostics... For this, TAB of the thyroid gland is prescribed with subsequent cytological examination of the material obtained.

What is Thyroid TAB

Patients are often afraid of the procedure for taking material from the thyroid gland, considering this procedure painful. The TAB method (fine-needle aspiration biopsy) used today minimizes traumatic effects and pain. The use of a thin needle (less than 1 mm in diameter) does not cause bleeding or scarring. The word "aspiration" in the name of the method means that the material is drawn into the needle.

Fine-needle aspiration biopsy helps to rule out malignancy.

Indications and contraindications

The appointment of TAB is indicated when a neoplasm in the thyroid gland larger than 10 mm is detected. There are some additional factors that warrant a biopsy:

  • progressive growth of the existing formation in the thyroid gland (if it has increased in size by more than 2 mm within six months);
  • the patient's stay in an area with an increased background radiation;
  • the presence of a close relative with an oncological disease;
  • an unusual form of neoplasm;
  • the presence of calcifications (accumulations of calcium salts);
  • preparation for radiotherapy (if the size of the formation is more than 5 mm).

Contraindications:

  • severe thyrotoxicosis;
  • acute thyroiditis.

Biopsy of the thyroid gland in patients with cardiovascular disease or low blood clotting ability is decided individually.

Where can the analysis be done

After determining the size of the tumor in the thyroid gland using an ultrasound examination, the patient receives a referral for a biopsy. TAB is carried out in many medical centers, it is recommended to prefer those that specialize in pathologies endocrine system.

Preparation for the procedure

Performing TAB does not require any special training. The doctor will need results before the procedure general analysis the patient's blood, data on its clotting ability and the level of thyroid hormones.

Full descriptions of early thyroid ultrasound will also be required, if performed.

Relevant for the doctor and information about chronic diseases, susceptibility to allergies and recent viral infections.

How is TAB

Fine needle aspiration biopsy of the thyroid gland together with the preparation step is carried out in just a few minutes. Most often, TAB is carried out under the control of ultrasound, this is necessary for the most accurate determination of the place of collection of cells (the material is taken from the walls of the neoplasm, since there may be pathological cells, while inside the neoplasm there is a colloidal liquid with thyroid hormones).

The patient lies face up on a couch with a small pillow under the neck and shoulders. Doctor lubricates antiseptic solution the surface of the skin at the injection site.

Before the introduction of the needle, an ultrasound probe is brought to the area of \u200b\u200bthe thyroid gland, then, observing what is happening on the screen of the device, the surgeon inserts a puncture needle.

The material with cells from the neoplasm is drawn into the needle with a syringe, after which it is laid out on special glasses and sent to the cytological laboratory for research.

Results and their interpretation

The cytologist examines the material received and gives a conclusion. The result is ready within three days after the procedure.

Analysis of the node material shows:

  • absence or presence of cancer cells;
  • signs of the development of a malignant process.

The lack of result is also possible. This is rare and means that an insufficient number of cells were taken for analysis.

Possible consequences

Complications are rare, but they are possible:

  • during a puncture, a certain amount of thyroid hormones enters the bloodstream from the neoplasm, while mild thyrotoxicosis is possible, the symptoms of which are palpitations, mood swings, sweating. This condition is not dangerous and passes quickly;
  • damage blood vessels sometimes causes swelling or bruising in the area of \u200b\u200bthe injection;
  • possible infection in the blood. This is a more dangerous complication. In case of swelling of the injection site, pain, swollen lymph nodes, consult a doctor.

Reviews

Alla, 27 years old, Barnaul: “They prescribed a biopsy of a tumor in the thyroid gland, I was afraid of this procedure, but the fear was in vain. The only thing I felt was a light injection, no more painful than an injection into a vein. The procedure itself took 2 minutes. A point remained from the injection, which passed in a couple of days. "

Oksana, Chita: “An ultrasound scan revealed a nodule in the thyroid gland, sent for a biopsy. The procedure is painless, just do not swallow during it, so as not to prevent the doctor from getting into the node. Everything took no more than 10 minutes. I completely forgot about the procedure after a couple of hours, I took the results in three days. "

What is a thyroid puncture and how is it taken?

The consequences of a puncture of the thyroid gland can be very unpleasant, but it is better to prevent the disease than to treat it. A biopsy is performed when it becomes necessary to determine which neoplasm has arisen in the organ - benign or malignant. The thyroid gland is examined through a puncture - to analyze the composition of the cells, they are taken and found out if they are cancerous. A similar study is prescribed if there are a large number of nodes in the thyroid gland or in the case when there is only one node, but its dimensions exceed one centimeter.

If you are scheduled for a puncture, you need to be clearly aware that it is needed to save life.

A benign tumor, with properly prescribed treatment, can be kept from degeneration.

The sooner cancer cells are found, the better the chances of coping with the tumor.

How is a puncture done?

Have you wondered how a thyroid puncture is taken? The main thing in this procedure is accuracy. The doctor inserts a syringe needle into the thyroid gland. The study is carried out only under ultrasound control, since the error can be fatal, and the nodes are usually quite small in size.

During the procedure, the contents of the node are drawn through the needle into the syringe. Then an in-depth microscopic examination is carried out, which makes it possible to establish the cellular composition of the material as accurately as possible.

The entire manipulation takes an average of 15-16 minutes, of which time the puncture itself is carried out within only three minutes.

Security guarantees

The vast majority of patients tolerate the procedure quite calmly.

There are widespread fears that a biopsy may have negative consequences, give an impetus to the degeneration of the node into malignant tumor... However, no such case is known in the world medical practice.

Of course, this method can hardly be called pleasant. But the resulting discomfort does not exceed the pain when taking, for example, blood from a vein.

Any discomfort during normal course completely disappears after two hours.

Only highly qualified specialists can provide guarantees of safety and minimal risk of possible complications.

Therefore, it is better to conduct such a study in a large specialized center, where a biopsy of the thyroid nodules is already long years performed at a high professional level.

Possible consequences

The most common unpleasant consequences include:

Complications requiring medical attention

It is imperative to seek medical help if any of these symptoms appear as a consequence of the puncture:

  • Bleeding;
  • Swallowing dysfunction;
  • Swelling at the puncture site;
  • High body temperature;
  • Cervical the lymph nodes increased quite a bit in size;
  • Fever.

With the help of a puncture of the thyroid gland, a diagnosis can be made fairly accurately.

It should be borne in mind that this study, like all others, does not give one hundred percent guarantee of the result.

The most accurate diagnostic methods: TAB of the thyroid gland

Fine-needle aspiration biopsy is a diagnostic method used for nodular neoplasms located at a relatively short distance from the skin. A prerequisite is the conduction of TAB of the thyroid gland under ultrasound control, since often the nodes do not exceed 2 cm in size, and in such cases it is necessary to determine their location with 100% accuracy.

In this article, we will talk about in which cases a fine-needle aspiration biopsy of the thyroid gland is indicated, the nuances of preparing for this study and the subtleties of its conduct. We will also consider contraindications and show examples of decoding biopsy analyzes.

Indications and contraindications for thyroid TAB

A biopsy of the thyroid gland is performed in the presence of nodes (see. In the thyroid gland, nodes: methods of diagnosis, treatment and prognosis of the disease), the size of which is more than 1 cm. The nodes, the size of which is less than this value, practically do not pose a danger to human health, but their biopsy can be performed in if the person was exposed to prolonged exposure, or during the examination, sonographic signs of cancer were detected.

This diagnosis is used to study the obtained material for the presence of cancer cells. A biopsy is performed for thyroid cysts, adenomas, autoimmune thyroiditis, goiter and other nodular neoplasms.

The use of this method is contraindicated for:

  • decompensated blood clotting disorders;
  • diseases associated with low permeability of the vessel walls (DIC syndrome);
  • mental illness during an exacerbation;
  • cardiovascular pathologies.

Features of the procedure

Preparation for a thyroid biopsy does not imply a number of specific requirements. The only thing worth doing is to limit bad habitsand remove all jewelry from the neck just before the procedure.

Next, we'll look at how a thyroid biopsy is done. The procedure is performed under ultrasound control, using syringes with a volume of 10 or 20 ml and needles with a diameter not exceeding 21G. It has been proven that the thinner the biopsy needle is, the less painful the procedure is. In addition, a smaller needle diameter has a positive effect on the test result by reducing the amount of blood that enters the smear.

The instruction assumes that the patient is placed on the couch in a horizontal position with his head thrown back. The neck is freed from clothing and jewelry, treated with an antiseptic solution and restricted with a sterile napkin.

A biopsy of the thyroid nodule takes 10-15 minutes. An endocrinologist surgeon makes a puncture while observing the position of the needle on the monitor of the ultrasound machine. When the needle enters the knot tissue, the doctor sucks in its contents, moving the needle from time to time in order to get materials from all parts of the knot.

After the doctor has taken the necessary material, he applies it to a special glass slide, making a smear. Most often, a goiter biopsy of the thyroid gland is done with 1-3 punctures at a time, for higher information content. During each puncture, they still take material from several parts of the node.

Important! During the procedure, do not move or swallow, as the needle can injure the thyroid gland and surrounding tissues.

Upon completion of the thyroid gland nodules, the puncture sites are sealed with a plaster, and within half an hour the patient can go home. After this procedure, there is no ban on visiting the pool, playing sports or swimming.

Feelings after the procedure

This diagnostic method is one of the most informative and painless, and the likelihood of any reactions occurring is no more than 10%.

However, if a biopsy of the thyroid gland was done, the consequences may be as follows:

  • a feeling of slight soreness in the neck area;
  • the formation of a hematoma at the puncture site;
  • dizziness when suddenly trying to get up after the procedure;
  • slight redness around the sites from which the material was taken.

Decoding the biopsy results

The results of a thyroid biopsy are most often given after 6-13 days after the examination. In private clinics, forms are used with which you can interpret the result of the analysis with your own hands, since they describe in some detail whether malignant cells were found, what their type and ratio.

The price for TAB thyroid varies on average from 2 to 8 thousand rubles, depending on the region and clinic in which the procedure will be carried out. After the biopsy of the thyroid gland, the test results are given to the patient.

Based on the results of education, there may be:

  • benign (negative);
  • malignant or suspected of being malignant (positive);
  • undefined (with follicular neoplasia);
  • uninformative.

Thyroid biopsy transcript may include concepts such as "nodular goiter", " colloid goiter"," Groups of cells of the follicular epithelium "- these concepts indicate that the disease is benign and will not cause irreparable harm to health.

The word “blood” in the results depends on how the thyroid biopsy is taken - if a too large needle was used for the procedure, the excess blood could affect the reliability of the result. If the results indicate that they are not informative, a second biopsy is necessary.

In cases where phrases such as "carcinoma", "suspicion of carcinoma", "medullary carcinoma", "malignancy is not excluded" were found during the interpretation of the result, more than 80% of them are talking about a malignant process.

From the photos and videos in this article, we learned on what indications it is necessary to carry out TAB thyroid glands, considered all the subtleties of the procedure and got acquainted with possible reactions after her.

According to statistics, the number of people suffering from thyroid disorders is increasing every year. The organ is often exposed to the development of various neoplasms. To determine their nature, different diagnostic techniques are used. One of them is TAB (fine needle aspiration biopsy).

Lumps that develop in the thyroid gland can be both benign and malignant. To determine the subsequent treatment, it is necessary to find out the nature of these formations. The most effective way to check this is TAB. This is a procedure for taking material from the node using a special needle and its further histological examination... Fine-needle biopsy is performed for any formations in the gland more than 1 centimeter in diameter.

Indications for the procedure

TAB is a procedure that should only be performed by a highly specialized doctor. Its essence is the study of thyroid tissue for the presence of atypical cells. A thin surgical needle up to 0.8 mm in diameter is inserted into the affected organ tissues. Thanks to the thin needle, the patient practically does not feel pain during its introduction into the tissues of the organ.

The procedure consists of several stages:

  • training,
  • direct material intake,
  • post-puncture skin treatment.

On average, TAB lasts about 15 minutes. The biopsy is necessarily accompanied by an ultrasound examination.

The need for anesthesia is determined immediately before the procedure. Many experts consider the use of anesthesia unnecessary, since its consequences are more painful and more dangerous than the sensations during a puncture.

TAB is prescribed in the following cases:

  • the presence of nodes more than 10 mm;
  • growth of formations exceeding 2 mm in six months;
  • the presence of close relatives;
  • detection and uneven contours during the conduct;
  • preparation for if the dimensions of the node are more than 5 mm.

In 90% of cases, an increase in thyroid nodules is not associated with cancerous formations.

Preparing for a diagnostic study

Before conducting fine-needle aspiration therapy for the thyroid gland, the patient is sent for laboratory tests:

  • general and biochemical blood test;
  • determination of blood clotting;
  • tests for hormones.

If necessary, the doctor may prescribe an additional ultrasound of the thyroid gland. No other special preparatory measures are required. TAB can be performed with or without food.

Carrying out TAB

Fine-needle biopsy is performed in the supine position. The patient lies down on a special couch, a pillow is placed under his shoulders to provide good access to the thyroid gland. Disposable syringes, ultra-thin needles for the collection of contents from the site must be prepared in advance.

Stages of TAB:

  • if necessary, anesthesia is done, but it is preferable to do without it;
  • the puncture site is treated with an antiseptic;
  • a needle is inserted into the walls of the thyroid gland;
  • the process is constantly monitored by an ultrasound machine to avoid accidental tissue injury;
  • to take the required amount of biopsy, the specialist may need to make an additional puncture;
  • the puncture site is sealed with a plaster;
  • the taken material is laid out on a special glass and sent to histology.

The puncture time takes 10-15 minutes. In some cases, the procedure takes up to 30 minutes. After taking the material, the patient should remain in the supine position for the same amount of time. No special recovery procedures are required after TAB. But during the day, you should avoid stress, do not wet the puncture site. After the puncture, a small bruise up to 5 mm may appear, but it goes away quickly.

If during the procedure it is not planned to use an ultrasound scan, it is better to contact another specialist. Ultrasound is necessary to accurately determine the site of material sampling. The biopsy must be taken from the wall of the formation, and not from the center. This is where cancer cells are concentrated. Before the needle is inserted into the node, the ultrasound probe is brought to the neck.

TAB is a diagnostic method and is not a means of monitoring the therapy process. Therefore, it is carried out, as a rule, 1 time.

Re-conducting is necessary in case:

  • uninformative result;
  • the rapid growth of education;
  • the presence of cancer symptoms.

Note! A malignant process detected with the help of TAB at an early stage greatly increases the patient's chances of recovery.

Decoding the results

The result of TAB thyroid can be obtained 3-5 days after the procedure. During this time, a detailed study of the material for the presence of atypical cells will be carried out. In 93% of cases, cytological examination gives an answer to what caused the enlargement of the thyroid nodule.

Today, the conclusions of cytology on the TAB of the thyroid gland are usually classified according to the Betzov classification of 2010

The results can be:

  • uninformative result - it is recommended to repeat the procedure;
  • - diagnosed in 80% of cases of benign formations;
  • undefined follicular lesion;
  • follicular tumor;
  • suspicion of thyroid cancer, repeated TAB is recommended;
  • cancer (carcinoma).

Learn about the causes and treatments for breastfeeding.

How to treat foliar fibroadenoma of the breast and how to avoid complications is written on the page.

Accuracy of fine needle biopsy

Fine needle biopsy results are not always correct. Sometimes clinical picture curved. The probability of an uninformative result can range from 4-20%. In such cases, the patient is advised to repeat the procedure to obtain additional material necessary for the diagnosis. If two times in a row TAB turned out to be uninformative, then surgical intervention.

False puncture results can be due to the following reasons:

  • lack of qualifications of a specialist;
  • mistakes during biopsy sampling;
  • misalignment of the needle into the knot due to its very small size.

Possible complications

Although biopsy is considered a safe diagnostic method, certain complications may occur:

  • Mild - it can be determined by elevated body temperature, rapid heart rate, mood swings. Such a complication is possible if the needle touches the colloid, from which some of the thyroid hormones entered the blood.
  • Infection of the body - occurs due to poor disinfection of instruments. An infection is indicated by an increase in temperature, inflammation in the area where the needle is inserted, and an increase in lymph nodes.
  • Bleeding occurs as a result of needle injury to blood vessels.

TAB of the thyroid gland is an informative method for diagnosing organ cancers. Thanks to the cytological examination of the material taken from the thyroid nodule, it is possible to reveal the presence or absence of atypical cells. The results of the analysis make it possible to accurately determine the further treatment tactics. In order for the TAB answer to be informative, it should only be carried out by an experienced specialist under ultrasound control.

Video on how thyroid TAB is performed under ultrasound control:

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

The result of a puncture of the thyroid gland with interesting photo materials and videos in this article is especially discussed.

The thyroid gland (glandula thyreoide) is a small organ of the endocrine system, located anteriorly and on the sides of the trachea. In a normal state, it is practically not detected by palpation.

Among the pathologies of other glands internal secretion, glandula thyreoide diseases are most common. The situation is complicated by the fact that such diseases can occur in a latent 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 increase in this organ. And the most accurate way to find out what exactly caused this phenomenon will help a fine-needle aspiration biopsy (TAB).

Unfortunately, one of the most formidable diseases of the thyroid gland, nodular neoplasms, is increasingly common. Among women who have reached the age of fifty, the frequency of occurrence of nodes reaches 50% of the population. With increasing age, this indicator only increases.

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

Medical tactics no longer provide for the complete cleaning of the gland tissue from pathological formations, but focuses on accurate diagnosis and the fight against only those of them that have entered the process of rebirth or have grown so much that they began to pose a threat to the work of surrounding organs. And this is where a puncture of the thyroid gland comes in handy, the results of the study obtained on the basis of which will help determine which node should be urgently removed, and which one can still be left alone for now.

Indications for TAB

An 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 by ultrasound or manual examination;
  • nodular, identified during either palpation with signs of malignant transformation, less than 10 mm in size.

Table: Indications for thyroid puncture:

In these cases, it is not worth delaying the study, because not only the health, but the very life of the patients is at risk.

What determines the cost of a thyroid node biopsy? The cost of a diagnostic puncture is equal to the numbers: 3000-6000 rubles.

This cost variation is formed as follows:

  1. biopsy "with" or "without" ultrasound control;
  2. how many formations have 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.

And a piece of tissue taken for research contains a number of cells, which can be used to determine the structure and nature of the pathology. It is this analysis that is an indication for surgery.

Research progress

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

Advantages of TAB over other methods of examination of thyroid nodular neoplasms:

  • Ease of diagnosis. Medical instruction to this diagnostic method indicates the absence of special complex equipment for research. The duration of the manipulation itself is 2-5 seconds.
  • Low cost of the procedure. The cost of puncture biopsy slightly exceeds the cost of ultrasound examination of the thyroid gland.
  • Almost complete absence of contraindications and complications.
  • Absolute reliability of examination results... This is the only method of establishing a definitive diagnosis.

The collection of material 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 cubic meters with needles having a diameter of 23G and below, up to 21G.

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

Anesthesia

The 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 introduction practically does not cause pain.

Important! Conducting anesthesia, both general and local injection, with 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 anesthesia make it much more risky 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 the time is taken by filling out written and electronic documentation:

Survey stage Performed manipulations

Patient registration, explanation of the TAB technique

Giving the patient a comfortable position - lying on the treatment table, with the ability to adjust the angle and height with a small pillow under the back, which allows the neck to be sufficiently extended. Treatment of the operating field with an antiseptic and delimiting it from the surrounding skin surface with a sterile napkin. Ultrasound examination of the gland and the actual puncture under the control of ultrasound equipment.

No special manipulations are required at this stage, except for manual fixation of a sterile cotton ball at the puncture site skin within 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 TAB

In order to prevent infection of the patient undergoing examination with all kinds of blood infections, such as HIV or hepatitis B, all stages should be carried out in strict accordance with the requirements of the standards of the sanitary and epidemic regime.

The most problematic subject in this regard is the ultrasonic sensor, the complete disinfection and sterilization of which is quite problematic. Most often, the destruction of pathogens that have fallen on 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 to undergo TAB, the higher his chance of getting an infection from one or even several previous patients.

The likelihood of nosocomial infection is even higher in the case of using puncture nozzles on the ultrasound probe, through which a puncture needle is passed in order to increase the accuracy of entering the node. However, at the same time, during the reverse stroke of the needle, biological fluids from the surface of the needle remain inside the puncture nozzle, and it is very problematic to remove them from there.

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

Therefore, to undergo TAB, you should apply only to those medical institutions that practice biopsy using the "free hand" technique. The essence of the method is to protect the ultrasound transducer with a disposable sterile cover that is put on and disposed of in the presence of the patient.

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

Procedure frequency

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 organ tissue. However, there are exceptions. If a benign nodule was diagnosed for the first time, but over time it quickly increased in size (which is not a prognostically favorable sign), a second fine-needle aspiration biopsy is performed to identify the cause of accelerated growth and exclude its malignancy.

Statistical data claim that the biopsy has no informative value of 5 to 25%, i.e. the answer obtained as a result of thyroid TAB does not give a clear answer to the question "Is the identified node malignant?" This situation also requires a second procedure at least 1 month after the primary puncture. If 3 procedures were uninformative, usually patients are advised to undergo surgery to remove the node.

The consultation is usually carried out by an endocrinologist surgeon - a specialist who deals with these procedures. Before TAB, he must examine the patient and additionally explain how the puncture of the thyroid gland is done.

Complications of TAB

There are no contraindications to this kind of research. During it, the following complications are possible:

  1. Phlebitis of veins.
  2. Tracheal 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 do not occur among experienced doctors.

Reading the result

The wording of the research result may look like this:

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

An informative result does not require a repetition of the biopsy; with its help, medical tactics are chosen. In case of a benign result, annual monitoring of the development of the neoplasm is required, and only when rapid growth (more than 10 mm per year) is observed, repeated TAB is performed.

Informativeness of the procedure

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

How to increase the information content of TAB?

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

Leading centers achieve an increase in the quality of TAB in the following ways:

  1. Coloring of drugs according to international protocols that create best conditions for their analysis.
  2. Use for cytological smears up to 6 glasses in order to preserve the material and increase the accuracy of research.
  3. Carrying out manipulations only by the most experienced specialists with experience in conducting at least 10,000 biopsies, with regular performance of 300 manipulations per week.
  4. Puncture is performed according to the rule: one node, - one injection, but at the same time collecting cellular material from various sites of the neoplasm, resorting to repeated injections only in case of excessively high density of the node.

Thanks to these innovations, the likelihood of obtaining informative results in leading medical centers has grown to 92%, above the European average.

Interpreting 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 the study of this gland differ from those for other organs.

The resulting biological materials are classified as follows:

  1. Suspicion of a malignant course with an inaccurate result.
  2. Malignant transformation of a tumor-like neoplasm.
  3. Obtained from a node, the development process of which is benign.
  4. Not suitable for research or not provided in sufficient volume.
  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.

With the possibility of a thorough study of the biopsy specimen, the cytologist will be able to make an accurate diagnosis.

Thyroid cysts

With the help of TAB it is possible not only, but also to determine its variety.

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

TAB for cysts, both single and multiple, acts as not only a diagnostic, but also a therapeutic procedure, contributing to the aspiration of pathological contents.

Hashimoto's thyroiditis

This disease is a chronic inflammation of the tissues of the glandula thyreoideae, which is of an autoimmune nature (read more). Pathology can be accompanied by the formation of nodal structures, which are investigated by means of TAB.

The cytological picture of the disease is characterized by:

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

TAB for this pathology is necessarily supplemented biochemical analysis blood.

Benign neoplasms

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

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

Thyroid cancer

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

Its cytological picture is characterized by:

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

Another type of malignant transformation - follicular cancer accounts for up to 15% of cases.

A biopsy specimen of this pathology is characterized by:

  1. Lack of colloid.
  2. Growth in the size of cell nuclei.
  3. By superimposing cellular elements on top of each other.
  4. The appearance of nuclei in the form of a circle or an oval.

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

  1. The polygonal shape of the cells.
  2. The presence of several nuclei inside one cell.
  3. Polymorphism, expressed in varying degrees.
  4. Scattered arrangement of cellular elements.
  5. The production of calcitonin in the cells of the neoplasm.

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 specimen contains cellular elements, whose structure is similar to follicles, but their size and shape are varied.

Cytology for all types of malignant transformation allows:

  1. Perform primary detection of malignancy.
  2. Track all changes in the cellular structure of the gland.
  3. After successful treatment, confirm recovery.

TAB is not used in part, only in cases where it is necessary to visually assess the cellular structure of the glandula thyreoideae, the cost of the procedure is low compared to the benefits it brings.

Puncture of the thyroid gland, the research results obtained with its help, allow to determine the pathology in 95% of cases, moreover, this can be done at the earliest stages. That, in turn, allows you to timely select medical tactics and, with the least loss, win over the pathology.

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

The result of a puncture of the thyroid gland with interesting photo materials and videos in this article is especially discussed.

The thyroid gland (glandula thyreoide) is a small organ of the endocrine system, located anteriorly and on the sides of the trachea. In a normal state, it is practically not detected by palpation.

Among the pathologies of other endocrine glands, diseases of the glandula thyreoide are most common. The situation is complicated by the fact that such diseases can occur in a latent 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 increase in this organ. And the most accurate way to find out what exactly caused this phenomenon will help a fine-needle aspiration biopsy (TAB).

Unfortunately, one of the most formidable diseases of the thyroid gland, nodular neoplasms, is increasingly common. Among women who have reached the age of fifty, the frequency of occurrence of nodes reaches 50% of the population. With increasing age, this indicator only increases.

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

Medical tactics no longer provide for the complete cleaning of the gland tissue from pathological formations, but focuses on accurate diagnosis and the fight against only those of them that have entered the process of rebirth or have grown so much that they began to pose a threat to the work of surrounding organs. And this is where a puncture of the thyroid gland comes in handy, the results of the study obtained on the basis of which will help determine which node should be urgently removed, and which one can still be left alone for now.

Indications for TAB

An 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 by ultrasound or manual examination;
  • nodular, identified during either palpation with signs of malignant transformation, less than 10 mm in size.

Table: Indications for thyroid puncture:

In these cases, it is not worth delaying the study, because not only the health, but the very life of the patients is at risk.

What determines the cost of a thyroid node biopsy? The cost of a diagnostic puncture is equal to the numbers: 3000-6000 rubles.

This cost variation is formed as follows:

  1. biopsy "with" or "without" ultrasound control;
  2. how many formations have 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.

And a piece of tissue taken for research contains a number of cells, which can be used to determine the structure and nature of the pathology. It is this analysis that is an indication for surgery.

Research progress

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

Advantages of TAB over other methods of examination of thyroid nodular neoplasms:

  • Ease of diagnosis... The medical instruction for this diagnostic method indicates the absence of special complex equipment for research. The duration of the manipulation itself is 2-5 seconds.
  • Low cost of the procedure. The cost of puncture biopsy slightly exceeds the cost of ultrasound examination of the thyroid gland.
  • Almost complete absence of contraindications and complications.
  • Absolute reliability of examination results... This is the only method of establishing a definitive diagnosis.

The collection of material 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 cubic meters with needles having a diameter of 23G and below, up to 21G.

Important! The thinner the needle is used for puncture, the less painful sensations from the puncture are, and the less blood from the injured tissues of the gland gets into the puncture.

Anesthesia

The 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 introduction practically does not cause pain.

Important! Conducting anesthesia, both general and local injection, with TAB does not make sense also because the pain during parenteral administration of the anesthetic exceeds that during the puncture itself. Plus, the possible complications of anesthesia make it much more risky than taking the 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 the time is taken by filling out written and electronic documentation:

Survey stage Performed manipulations

Patient registration, explanation of the TAB technique

Giving the patient a comfortable position - lying on the treatment table, with the ability to adjust the angle and height with a small pillow under the back, which allows the neck to be sufficiently extended. Treatment of the operating field with an antiseptic and delimiting it from the surrounding skin surface with a sterile napkin. Ultrasound examination of the gland and the actual puncture under the control of ultrasound equipment.

No special manipulations are required at this stage, except for manual fixation of a sterile cotton ball at the puncture site of the 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 TAB

In order to prevent infection of the patient undergoing examination with all kinds of blood infections, such as HIV or hepatitis B, all stages should be carried out in strict accordance with the requirements of the standards of the sanitary and epidemic regime.

The most problematic subject in this regard is the ultrasonic sensor, the complete disinfection and sterilization of which is quite problematic. Most often, the destruction of pathogens that have fallen on 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 to undergo TAB, the higher his chance of getting an infection from one or even several previous patients.

The likelihood of nosocomial infection is even higher in the case of using puncture nozzles on the ultrasound probe, through which a puncture needle is passed in order to increase the accuracy of entering the node. However, at the same time, during the reverse stroke of the needle, biological fluids from the surface of the needle remain inside the puncture nozzle, and it is very problematic to remove them from there.

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

Therefore, to undergo TAB, you should apply only to those medical institutions that practice biopsy using the "free hand" technique. The essence of the method is to protect the ultrasound transducer with a disposable sterile cover that is put on and disposed of in the presence of the patient.

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

Procedure frequency

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 organ tissue. However, there are exceptions. If a benign nodule was diagnosed for the first time, but over time it quickly increased in size (which is not a prognostically favorable sign), a second fine-needle aspiration biopsy is performed to identify the cause of accelerated growth and exclude its malignancy.

Statistical data claim that the biopsy has no informative value of 5 to 25%, i.e. the answer obtained as a result of thyroid TAB does not give a clear answer to the question "Is the identified node malignant?" This situation also requires a second procedure at least 1 month after the primary puncture. If 3 procedures were uninformative, usually patients are advised to undergo surgery to remove the node.

The consultation is usually carried out by an endocrinologist surgeon - a specialist who deals with these procedures. Before TAB, he must examine the patient and additionally explain how the puncture of the thyroid gland is done.

Complications of TAB

There are no contraindications to this kind of research. During it, the following complications are possible:

  1. Phlebitis of veins.
  2. Tracheal 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 do not occur among experienced doctors.

Reading the result

The wording of the research result may look like this:

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

An informative result does not require a repetition of the biopsy; with its help, medical tactics are chosen. In case of a benign result, annual monitoring of the development of the neoplasm is required, and only when rapid growth (more than 10 mm per year) is observed, repeated TAB is performed.

Informativeness of the procedure

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

How to increase the information content of TAB?

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

Leading centers achieve an increase in the quality of TAB in the following ways:

  1. Coloring of drugs according to international protocols that create the best conditions for their analysis.
  2. Use for cytological smears up to 6 glasses in order to preserve the material and increase the accuracy of research.
  3. Carrying out manipulations only by the most experienced specialists with experience in conducting at least 10,000 biopsies, with regular performance of 300 manipulations per week.
  4. Puncture is performed according to the rule: one node, - one injection, but at the same time collecting cellular material from various sites of the neoplasm, resorting to repeated injections only in case of excessively high density of the node.

Thanks to these innovations, the likelihood of obtaining informative results in leading medical centers has grown to 92%, above the European average.

Interpreting 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 the study of this gland differ from those for other organs.

The resulting biological materials are classified as follows:

  1. Suspicion of a malignant course with an inaccurate result.
  2. Malignant transformation of a tumor-like neoplasm.
  3. Obtained from a node, the development process of which is benign.
  4. Not suitable for research or not provided in sufficient volume.
  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.

With the possibility of a thorough study of the biopsy specimen, the cytologist will be able to make an accurate diagnosis.

Thyroid cysts

With the help of TAB it is possible not only, but also to determine its variety.

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

TAB for cysts, both single and multiple, acts as not only a diagnostic, but also a therapeutic procedure, contributing to the aspiration of pathological contents.

Hashimoto's thyroiditis

This disease is a chronic inflammation of the tissues of the glandula thyreoideae, which is of an autoimmune nature (read more). Pathology can be accompanied by the formation of nodal structures, which are investigated by means of TAB.

The cytological picture of the disease is characterized by:

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

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

Benign neoplasms

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

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

Thyroid cancer

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

Its cytological picture is characterized by:

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

Another type of malignant transformation - follicular cancer accounts for up to 15% of cases.

A biopsy specimen of this pathology is characterized by:

  1. Lack of colloid.
  2. Growth in the size of cell nuclei.
  3. By superimposing cellular elements on top of each other.
  4. The appearance of nuclei in the form of a circle or an oval.

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

  1. The polygonal shape of the cells.
  2. The presence of several nuclei inside one cell.
  3. Polymorphism, expressed in varying degrees.
  4. Scattered arrangement of cellular elements.
  5. The production of calcitonin in the cells of the neoplasm.

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 specimen contains cellular elements, whose structure is similar to follicles, but their size and shape are varied.

Cytology for all types of malignant transformation allows:

  1. Perform primary detection of malignancy.
  2. Track all changes in the cellular structure of the gland.
  3. After successful treatment, confirm recovery.

TAB is not used in part, only in cases where it is necessary to visually assess the cellular structure of the glandula thyreoideae, the cost of the procedure is low compared to the benefits it brings.

Puncture of the thyroid gland, the research results obtained with its help, allow to determine the pathology in 95% of cases, moreover, this can be done at the earliest stages. That, in turn, allows you to timely select medical tactics and, with the least loss, win over the pathology.

Thyroid TAB receives in medical practice increasing popularity. The fine needle aspiration biopsy technique increases the chances of recovery for endocrinologist patients. The method provides quite extensive information and allows differentiation of nodal pathologies. The diagnostic method is possible on early stages identification or suspicion of the development of diseases.

TAB is a medical procedure performed by a narrow specialist. The bottom line is the study of thyroid tissue. The study is cytological in nature.

For an ordinary person, this explanation paints a picture of a procedure that will be accompanied by pain from penetration into the body. In fact, the method is painless. Its speed is 2 - 3 seconds. A thin surgical needle with a diameter of 0.6 - 0.8 mm is inserted into the affected tissues and the node. You cannot deceive the patient that he will not feel anything at all. It is clear that any puncture is an unpleasant sensation. The patient will be uncomfortable, but there will be no pain. The whole procedure, including preparation, immediate actions of the doctor, treatment of the puncture skin after TAB, will take about 15 minutes. In some medical institutionsperforming such procedures, patients are offered anesthesia or other methods of pain relief. Experienced specialists consider this unnecessary, to some extent harmful. If we compare the pain from anesthesia (coming out of anesthesia) and a puncture, then complications from the use of narcotic substances are more painful and dangerous.

Many patients ask for anesthesia before TAB, hoping to improve their condition and facilitate the procedure itself. But in reality this is not entirely true.

The pain from a puncture with a thin needle is less severe than the conditions resulting from local anesthesia:

  • allergy;
  • anaphylactic shock;
  • dyspepsia;
  • pain in the cervical muscles;
  • pain when moving the throat, internal and external;
  • trembling limbs.

After the puncture procedure with a fine needle method, the temperature may rise, another consequence is coughing. But both complications are short-lived. The temperature goes away after 5-7 hours, the cough disappears after a day.

The doctor informs the patient about the requirements for the preparation of the procedure in advance.

Patients are advised to give up food before many methods of medical research. The TAB method of the thyroid gland does not imply such restrictions. Food taken on the day of the procedure will not affect the test results. On the contrary, doctors advise to eat. Food will allow the patient to feel calm, balanced. There will be no thoughts about the desire to complete the diagnosis as soon as possible, nor will there be any desire to eat. The person during the procedure will be calm, nothing will distract him from medical examinations.

The medical procedure takes place under the supervision of an ultrasound examination. A biopsy under an ultrasound scan will avoid damage to tissues, organs and systems. All adjacent organs will remain intact and not affected by the needle. In addition, ultrasound will help to obtain more accurate data.

The picture contains the following information:

  • sizes;
  • echogenicity;
  • site content;
  • calcifications;
  • the nature of the blood supplying streams.

TAB of the thyroid gland under ultrasound control will give information about the localization of the nodular seal, the location:

All taken tissues are marked by a specialist. Doctor's notes will help to avoid mistakes or inaccuracies. The specialist performs as many punctures as required based on the data obtained from the ultrasound. Doctors warn about possible microtraumas.

Biopsy damages:

  • small vessels;
  • subcutaneous tissue;
  • body fat;
  • muscles along the puncture path.

All minor lesions heal within a few days after surgical procedures.

According to medical research, a large percentage of patients believe that a biopsy can activate and provoke terrible pathologies... Patients believe that oncology will develop. Biopsy in this sense is equivalent to injury. Experts refute this opinion. They provide information of a completely opposite nature. The needle cannot change the course of the disease, convert it into a cancerous form. Moreover, the method allows you to remove cystic formations from any part of the thyroid gland. More often, a biopsy is not an impetus to cancer, but its diagnosis. The procedure reveals the neglect of the disease, the extreme stage of its development.

What is the fallacy of opinion:

  1. The biopsy showed no result due to its small size. A different method was required for detecting tumor formations, for example, histology.
  2. Blind biopsy without ultrasound control can damage the gland tissue. It is important here that the TAB procedure is carried out by a professional.
  3. Inadequacy of the doctor's qualifications, inability to decipher the data obtained, to understand the analysis of the biopsy.

Statistics provide positive data on the results of the procedure: only 4% give false information. But in case of any doubt or insufficient data, doctors prescribe a second study or change the diagnostic method.

The patient prepares himself for this type of diagnosis. The patient prepares mainly psychologically. He attunes himself to the need for the method recommended by the doctor.

From the medical requirements of training, a complex of tests is distinguished:

  • blood;
  • hormonal levels;
  • blood clotting rate.

All tests are submitted in one day, the results are valid for 3 months. Additional information can provide pre-biopsy results ultrasound examinations.

A protocol is kept for each visit to the endocrinologist and patient examinations. Control sheets will allow you to get more information, increase data on the course of the disease.

Have questions?

Report a typo

Text to be sent to our editors:

Send message