Monday, June 06, 2005

Recommendations for FNA of Non-Palpable Thyroid Nodules and Neck Lymph Nodes

At the first meeting of the Academy of Clinical Thyroidologists, the group produced a position paper on non-palpable thyroid nodules, and neck lymph nodes.

Here are the indications for Ultrasound guided FNA of thyroid
micronodules( 0.5-1cm):

1.History of radiation to head and neck during childhood.
2.Family history of medullary, or papillary thyroid cancer.
3.Micronodule in remaining lobe after hemithyroidectomy for thyroid cancer.
4.Hypoechoic micronodule with one of the following ultrasound findings.

A.Blurred margins
B.Intranodular vascularity
C.Taller that wide
E.Significant neck lymphadenopathy

Our indications for FNA of neck lymph nodes found in thyroid cancer patients

Any node >5 mm in height without a hilar line, and having one or more of the following characteristics:

A.Anterior-posterior/transverse ratio >0.5, in the transverse view.
C.Cystic Necrosis
D.Peripheral vascularity
E.Causes deviation of the internal jugular vien

We recommend all thyroid nodules >2 cm be biopsied, unless it is known to be "hot" on I/123 Iodine scanning.

Nodules 1.1-1.9 cm were felt to need biopsy, but the judgement of the endocrinoiologist was paramount in this decision. Some features such as comet tail, and hyperechogenicity were felt to be reasons to delay FNA, as long as there would be follow up obervation.

The full text of the position paper can be found found on
This includes references.
The work of H.Jack Baskin M.D., expert in thyroid ultrasound, was the driving force behind these recommendations.

Thank you,

Richard Guttler
The Thyroid Blog
The Thyroid Home Page

No comments: