jamunjar-logo
whatsapp
cartmembermenu
Search for
"test & packages"
"physiotherapy"
"heart"
"lungs"
"diabetes"
"kidney"
"liver"
"cancer"
"thyroid"
"bones"
"fever"
"vitamin"
"iron"
"HTN"

Thyroid mass Biopsy - XL

Biopsy
image

Report in 288Hrs

image

At Home

nofastingrequire

No Fasting Required

Details

FNAC/biopsy for histopathology.

₹888₹1,269

30% OFF

Thyroid Mass Biopsy - XL Comprehensive Guide

  • Why is it done?
    • Test Purpose: The Thyroid Mass Biopsy - XL is a minimally invasive diagnostic procedure that obtains tissue samples from thyroid nodules or masses for microscopic examination to determine if malignancy is present.
    • Primary Indications: Evaluation of thyroid nodules with suspicious ultrasound characteristics (hypoechoic, irregular margins, increased vascularity), nodules >1 cm in size, nodules with rapid growth, palpable masses, or family history of thyroid cancer.
    • Typical Timing: Performed when thyroid ultrasound demonstrates a nodule requiring tissue diagnosis, typically after initial imaging assessment or when previous fine-needle aspiration biopsy (FNAB) results are indeterminate (Bethesda Category III or IV).
    • Clinical Applications: Rule out thyroid cancer (papillary, follicular, medullary, anaplastic carcinoma), distinguish benign from malignant lesions, guide treatment decisions regarding surgery versus observation, and provide definitive diagnosis for nodules with equivocal cytology.
  • Normal Range
    • Negative/Benign Result: Tissue shows normal thyroid follicular cells, colloid, normal thyroid architecture without atypia, malignant cells, or suspicious features. May be classified as 'Non-Diagnostic,' 'Benign,' or 'Follicular Lesion of Undetermined Significance (FLUS)' per Bethesda System for Reporting Thyroid Cytopathology.
    • Benign Categories: Hashimoto's thyroiditis, adenomatous hyperplasia, colloid nodule, follicular adenoma, or cystic changes with normal background. Risk of malignancy: <3%.
    • Positive/Malignant Result: Tissue demonstrates malignant cells, papillary carcinoma features (nuclear grooves, pseudoinclusions), medullary carcinoma, anaplastic carcinoma, or lymphoma cells. Risk of malignancy: >95%.
    • Indeterminate Results: Atypia of Undetermined Significance (AUS) - intermediate risk (5-15% malignancy); Follicular Neoplasm - suggests follicular carcinoma potential (15-30% malignancy); Suspicious for Malignancy - concerning cytology but not diagnostic (50-75% malignancy).
    • Sample Adequacy: Adequate sample contains sufficient thyroid follicular cells for interpretation (minimum 6-12 groups with 10 cells each). Non-diagnostic samples may require repeat biopsy.
  • Interpretation
    • Benign Interpretation (Risk <3%): Tissue shows mature thyroid follicles with normal colloid, minimal nuclear enlargement, normal mitotic activity, and absence of vascular invasion. Clinical management typically involves observation, ultrasound follow-up in 6-12 months, or TSH suppression if indicated. Surgery usually not recommended unless nodule is enlarging or causing compression symptoms.
    • Atypia of Undetermined Significance (5-15% Malignancy): Shows mild cellular atypia, slight nuclear irregularities, or architectural abnormalities that cannot be definitively classified. May include scattered atypical follicular cells without diagnostic features of papillary or follicular neoplasm. Molecular testing (ThyroSeq, Afirma) often recommended. Management: repeat biopsy, consider lobectomy, or closer monitoring depending on clinical context.
    • Follicular Lesion of Undetermined Significance (FLUS) (5-15% Malignancy): Demonstrates follicular architecture abnormality or increased cellularity but lacks diagnostic criteria for follicular neoplasm. May show hyperplasia, oncocytic change, or architectural distortion. Requires molecular testing or repeat sampling to stratify risk. Management similar to AUS; many patients managed conservatively with surveillance.
    • Follicular Neoplasm (15-30% Malignancy): Shows cellular follicular lesion with increased cellularity, intact or partially present capsule, and uniform nuclei without papillary features. Cannot distinguish benign follicular adenoma from follicular carcinoma on cytology alone; requires histologic evaluation of capsular/vascular invasion. Typically managed with thyroid lobectomy to assess for invasion. Molecular testing may help stratify risk.
    • Suspicious for Malignancy (50-75% Malignancy): Demonstrates significant nuclear atypia, irregular nuclear membranes, increased nuclear-to-cytoplasmic ratio, abnormal mitotic figures, or architectural patterns suggestive of malignancy but lacking definitive diagnostic criteria. May represent papillary carcinoma variant or poorly differentiated thyroid cancer. Strong recommendation for total thyroidectomy.
    • Malignant (>95% Malignancy): Shows definitive malignant cells with diagnostic criteria for specific histologic type: papillary carcinoma (nuclear grooves, pseudoinclusions, pale nuclei), medullary carcinoma (amyloid stroma, spindle cells), anaplastic carcinoma (marked nuclear pleomorphism, high mitotic rate), or lymphoma (monomorphic infiltrate). Indicates need for immediate surgical intervention and comprehensive thyroid cancer treatment protocol.
    • Factors Affecting Interpretation: Sample quality and adequacy, degree of preservation, presence of obscuring blood or colloid, observer experience, availability of immunohistochemical stains, molecular testing capabilities, clinical context (nodule size, ultrasound features, TSH level), and comparison with prior biopsies if available.
  • Associated Organs
    • Primary Organ - Thyroid Gland: Endocrine gland located in anterior neck responsible for producing thyroid hormones (T3, T4) that regulate metabolism. The thyroid is composed of follicular cells (produce thyroid hormones) and parafollicular C cells (produce calcitonin). Biopsy samples cells from this organ.
    • Associated Endocrine Conditions: Hypothyroidism, hyperthyroidism, Graves' disease, Hashimoto's thyroiditis, multinodular goiter, thyroid dysfunction, and follicular epithelial abnormalities.
    • Thyroid Cancer Types Diagnosed: Papillary thyroid carcinoma (PTC, 80-85% of cases, generally favorable prognosis), follicular thyroid carcinoma (FTC, 10-15%, intermediate prognosis), medullary thyroid carcinoma (MTC, 3-5%, neuroendocrine origin), anaplastic thyroid carcinoma (ATC, 1-2%, most aggressive), and primary thyroid lymphoma.
    • Adjacent Structures at Risk: Recurrent laryngeal nerve (may be affected by malignant invasion causing voice hoarseness), superior laryngeal nerve, trachea, esophagus, carotid artery, and jugular veins.
    • Systemic Effects of Thyroid Cancer: Metastatic dissemination to lungs (50-80% in advanced PTC), bones, brain, and lymph nodes; affects cardiovascular system through altered thyroid hormone metabolism; impacts overall metabolic function and systemic health.
    • Lymph Node Involvement: Central compartment cervical lymph nodes (Level VI), lateral cervical lymph nodes (Levels I-V), and superior mediastinal lymph nodes may harbor metastatic disease requiring modified neck dissection and comprehensive staging.
  • Follow-up Tests
    • Molecular Testing (if Indeterminate Results): ThyroSeq (next-generation sequencing detects mutations), Afirma (gene expression classifier), or ThyGenX (cancer gene panel) helps stratify malignancy risk in AUS and FLUS categories, improving diagnostic accuracy and guiding management.
    • Immunohistochemical (IHC) Staining: PAX8, TTF-1, cytokeratin markers to confirm thyroid origin; CK19, HBME-1 for papillary carcinoma; calcitonin for medullary carcinoma; or p53 for anaplastic features. May be performed on original or repeat biopsy specimens.
    • Thyroid Function Tests: TSH, Free T4, Total T3 levels; particularly important before surgery to optimize perioperative status and assess for thyroid dysfunction.
    • Repeat Ultrasound Assessment: Follow-up thyroid ultrasound 6-12 months after benign biopsy to assess for nodule growth, change in imaging characteristics, or new suspicious features. If nodule enlarges, repeat biopsy may be warranted.
    • Repeat Fine-Needle Aspiration (FNA): May be performed if XL biopsy is non-diagnostic or if clinical suspicion remains high. Core biopsy may follow inconclusive FNA results.
    • Advanced Imaging Studies: CT neck/chest or MRI for staging if malignancy confirmed; assess for invasion, lymph node involvement, or distant metastasis. PET scan may be indicated for high-risk cases.
    • Serum Thyroglobulin and Anti-Thyroglobulin Antibodies: Baseline assessment before thyroidectomy in confirmed thyroid cancer; used for postoperative surveillance and recurrence detection.
    • Calcitonin Testing (if Medullary Carcinoma Suspected): Serum calcitonin and CEA levels for baseline and postoperative monitoring; important for familial medullary thyroid cancer screening and management.
    • Genetic Testing: RET gene mutation testing if medullary carcinoma diagnosed; BRAF V600E mutation if papillary carcinoma with aggressive features; TP53 or TERT promoter mutations in anaplastic carcinoma.
    • Thyroid Cancer Risk Stratification: Comprehensive assessment incorporating histopathology, TNM staging, age, gender, tumor size, aggressive histologic variants, and molecular markers to determine initial risk stratification and guide treatment intensity.
    • Surgical Consultation: Endocrinologic surgeon evaluation for all malignant and suspicious results; lobectomy versus total thyroidectomy decision based on final histopathology, molecular data, TNM staging, and clinical context.
  • Fasting Required?
    • Fasting Status: No - Fasting is NOT required for Thyroid Mass Biopsy - XL. This is a tissue sampling procedure unrelated to metabolic blood studies.
    • Pre-Procedure Preparation: Patient may eat and drink normally unless anesthesia is required. Wear comfortable, loose-fitting clothing that allows neck access. Arrive 15-30 minutes early for patient registration and consent documentation.
    • Medication Instructions: DISCONTINUE anticoagulants (warfarin, apixaban, rivaroxaban, dabigatran) 3-5 days prior to procedure or as directed by physician; HOLD aspirin and NSAIDs (ibuprofen, naproxen) 1 week prior if possible. CONTINUE regular thyroid medications (levothyroxine). Notify provider of all medications, especially antiplatelet agents and anticoagulants.
    • Special Instructions: If conscious sedation will be used, arrange for designated driver (do not drive for 12-24 hours). Bring insurance card and photo identification. Inform radiologist/pathologist of any pregnancy, bleeding disorders, or recent biopsy history. Avoid heavy lifting or strenuous exercise for 24 hours post-procedure.
    • Post-Procedure Care: Apply ice pack to neck for 10-15 minutes if swelling occurs. Throat soreness or mild neck discomfort is normal; acetaminophen or ibuprofen may be used. Resume normal diet and activities after appropriate recovery period. Avoid touching biopsy site for 48 hours.
    • When to Contact Physician: Report severe neck swelling, difficulty breathing or swallowing, persistent hoarseness beyond 48 hours, excessive bleeding from needle site, fever >101°F, or signs of infection. Contact provider immediately if shortness of breath or signs of aspiration occur.

How our test process works!

customers
customers