Ultrasound-Guided Fine-Needle Biopsy of Thyroid Nodules

  • Mark A. LupoEmail author
  • Daniel S. Duick


There are multiple benefits in performing a diagnostic neck ultrasound examination prior to a thyroid nodule fine-needle aspiration (FNA). These benefits include confirming that a biopsy is required and determining the size and position of a nodule, which allows better selection of needle length and needle size. In patients with a multinodular goiter, ultrasound assures biopsy of the dominant nodule or the nodules most likely to be malignant—those having microcalcifications, increased vascularity, marked hypoechogenicity, blurred irregular borders, or other characteristics associated with malignancy. Finally, ultrasound may redirect the FNA to other areas of suspicion, such as an enlarged, suspicious lymph node or identify an incidental parathyroid adenoma. Once a physician acquires the skill to perform diagnostic neck ultrasonography, it is a simple progression to combine the two procedures into an ultrasound-guided FNA (UGFNA).


Fine needle Aspiration Biopsy Ultrasound guided Nodule FNA 



American Association of Clinical Endocrinologists


American Thyroid Association


Fine-needle aspiration


International normalized ratio


Liquid-based cytology


Rapid on-site evaluation


Ultrasound-guided fine-needle aspiration


  1. 1.
    Miller JM, Hamburger JI, Kini SR. The impact of needle biopsy on the preoperative diagnosis of thyroid nodules. Henry Ford Hosp Med J. 1980;28:145.PubMedGoogle Scholar
  2. 2.
    Takashima S, Fukuda H, Kobayashi T. Thyroid nodules: clinical effect of ultrasound-guided fine needle aspiration biopsy. J Clin Ultrasound. 1994;22:536–42.CrossRefGoogle Scholar
  3. 3.
    Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography-guided fine needle aspiration biopsy of thyroid nodules. Thyroid. 1998;8:15–21.CrossRefGoogle Scholar
  4. 4.
    Carmeci C, Jeffery RB, McDougall IR, Noweis KW, Weigel RJ. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses. Thyroid. 1998;8:283–9.CrossRefGoogle Scholar
  5. 5.
    Yang GCH, Liebeskind D, Messina AV. Ultrasound-guided fine-needle aspiration of the thyroid assessed by ultrafast papanicolaou stain: data from 1,135 biopsies with a two to six year follow-up. Thyroid. 2001;11:581–9.CrossRefGoogle Scholar
  6. 6.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.CrossRefGoogle Scholar
  7. 7.
    Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedus L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and Management of Thyroid Nodules – 2016 update. Endocr Pract. 2016;22(5):622–39.PubMedGoogle Scholar
  8. 8.
    Hagag P, Strauss S, Weiss M. Role of ultrasound-guided fine-needle aspiration biopsy in evaluation of nonpalpable nodules. Thyroid. 1998;8:989–95.CrossRefGoogle Scholar
  9. 9.
    Leenhardt L, Hejblum G, Franc B, Fediaevsky LD, Delbot T, Le Guillozic D, et al. Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules. J Clin Endocrinol Metab. 1999;84:24–8.CrossRefGoogle Scholar
  10. 10.
    Ito Y, Miyauchi A, Kobayashi K, Miya A. Prognosis and growth activity depend on patient age in clinical and subclinical papillary thyroid carcinoma. Endocr J. 2014;61(3):205–13.CrossRefGoogle Scholar
  11. 11.
    Brito JP, Ito Y, Miyauchi A, Tuttle RM. A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. Thyroid. 2016;26(1):144–9.CrossRefGoogle Scholar
  12. 12.
    Lo WC, Cheng PW, Wang CT, Yeh ST, Liao LJ. Pain levels associated with ultrasound-guided fine-needle aspiration biopsy for neck masses. Head Neck. 2014;36(2):252–6.CrossRefGoogle Scholar
  13. 13.
    Leboulleux S, Borget I, Labro S, Bidault S, Vielh P, Hartl D, Dauchy S, Chougnet CN, Girard E, Azoulay S, Mirghani H, Berdelou A, Lumbroso J, Deandreis D, Baudin E, Schlumberger M, Laurent S. Frequency and intensity of pain related to thyroid nodule fine-needle aspiration cytology. Thyroid. 2013;23(9):1113–8.CrossRefGoogle Scholar
  14. 14.
    Polyzos SA, Anastasilakis AD. Clinical complications following thyroid fine-needle biopsy: as systematic review. Clin Endocrinol. 2009;71:157–65.CrossRefGoogle Scholar
  15. 15.
    Khoo TK, Baker CH, Hallanger-Johnson J, Tom AM, Grant CS, Reading CC, et al. Comparison of ultrasound-guided fine-needle aspiration biopsy with core-needle biopsy in the evaluation of thyroid nodules. Endocr Pract. 2008;14(4):426–31.CrossRefGoogle Scholar
  16. 16.
    Choi YJ, Baek JH, Suh CH, Shim WH, Jeong B, Kim JK, Song DE, Kim TY, Chung KW, Lee JH. Core-needle biopsy versus repeat fine-needle aspiration for thyroid nodules initially read as atypia/follicular lesion of undetermined significance. Head Neck. 2016;39(2):361–9. (epub).CrossRefGoogle Scholar
  17. 17.
    Suh CH, Baek JH, Kim KW, Sung TY, Kim TY, Song DE, Choi YJ, Lee JH. The role of Core-needle biopsy for thyroid nodules with initially nondiagnostic fine-needle aspiration results: a systematic review and meta-analysis. Endocr Pract. 2016;22(6):679–88.CrossRefGoogle Scholar
  18. 18.
    Abu-Yousef MM, Larson JH, Kuehn DM, Wu AS, Laroia AT. Safety of ultrasound-guided fine needle aspiration biopsy of neck lesions in patients taking antithrombotic/anticoagulant medications. Ultrasound Q. 2011;27(3):157–9.CrossRefGoogle Scholar
  19. 19.
    Lyle MA, Dean DS. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules in patients taking novel oral anticoagulants. Thyroid. 2015;25(4):373–6.CrossRefGoogle Scholar
  20. 20.
    Denham SL, Ismail A, Bolus DN, Lockhart ME. Effect of anticoagulation medication on the thyroid fine-needle aspiration pathologic diagnostic sufficiency rate. J Ultrasound Med. 2016;35(1):43–8.CrossRefGoogle Scholar
  21. 21.
    Tsao G, Orloff L. Clinician-performed thyroid ultrasound-guided fine-needle aspiration. Otolaryngol Clin N Am. 2014;47:509–18.CrossRefGoogle Scholar
  22. 22.
    Crockett JC. “The thyroid nodule” fine-needle aspiration biopsy technique. J Ultrasound Med. 2011;30:685–94.CrossRefGoogle Scholar
  23. 23.
    Zajdela A, de Maublanc MA, Schlienger P, Haye C. Cytologic diagnosis of orbital and periorbital palpable tumors using fine-needle sampling without aspiration. Diagn Cytopathol. 1986;2:17–20.CrossRefGoogle Scholar
  24. 24.
    de Carvalho GA, Paz-Filho G, Cavalcanti TC, Graf H. Adequacy and diagnostic accuracy of aspiration vs. capillary fine needle thyroid biopsies. Endocr Pathol. 2009;20(4):204–8.CrossRefGoogle Scholar
  25. 25.
    Tublin ME, Martin JA, Rollin LJ, Pealer K, Kurs-Lasky M, Ohori NP. Ultrasound-guided fine-needle aspiration versus fine-needle capillary sampling biopsy of thyroid nodules: does technique matter? J Ultrasound Med. 2007;26(12):1697–701.CrossRefGoogle Scholar
  26. 26.
    Witt BL, Schmidt RL. Rapid onsite evaluation improves the adequacy of fine-needle aspiration for thyroid lesions: as systematic review and meta-analysis. Thyroid. 2013;23:428–35.CrossRefGoogle Scholar
  27. 27.
    Lupo MA. Thyroid nodule evaluation: US-FNA and on-site cytology assessment. Endocr Pract. 2013;19(4):732–4.CrossRefGoogle Scholar
  28. 28.
    Abraham D. A method using superconcentrated gelatin and a novel phantom suspension system for ultrasound-guided thyroid biopsy training. Thyroid. 2014;24(11):1662–3.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Thyroid and Endocrine Center of FloridaSarasotaUSA
  2. 2.Florida State University, College of Medicine, Sarasota Florida CampusSarasotaUSA
  3. 3.University of Arizona College of MedicinePhoenixUSA
  4. 4.Endocrinology Associates, PAScottsdaleUSA

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