Wait time between biopsies?

3043 Views 2 Replies 2 Participants Last post by Ulfilas, Apr 14, 2013

Ulfilas

Discussion Starter · Apr 13, 2013

Hello everyone! I am new to this board. I appreciate having the opportunity to join this community.

I am male, 46, generally in very good health. I have a single nodule, left lobe, coincidentally discovered during a carotid ultrasound scan (checking for heart disease--happy to report my cardiovascular system is in tip-top shape at least). I had another ultrasound of the complete thyroid a week after the carotid scan. It came back as this: "A single hypoechoic solid nodule with peripheral and possible internal microcalcifications is identified in the mid left lobe measuring .9 x 1.1 x .9 cm." My blood work came back with normal levels of thyroid-related hormones (e.g. T4, THS, TPO normal, though slightly elevated normetanephrine--I know that's not thyroid specific but getting that checked too).

I had FNA biopsy a week and a half ago, but it was unsatisfactory, so I am getting another, but I have to wait 6-8 weeks. My first question is, why the wait? Why can't it just be done a week or 2 later?

Next question, from what I have read (e.g., Dr Jill Langer, Univ of Pennsylvania http://www.penncancer.org/pdf/LangerThyroidNodules.pdf ), microcalcifications + hyperechoic = 96% Specificity for cancer. I am curious as to your thoughts on this. I hate the thought of waiting 2 months if it seems so likely to be cancer. Is there really a good reason for such a long wait? The next FNA is going to be done by a radiological expert (my endocrinologist did the original one with ultrasound guidance), and they will supposedly have a pathologist on hand to immediately check results.

Thanks in advance for your thoughts and support!
--Piet

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joplin1975

· #2 · Apr 13, 2013 (Edited by Moderator)

By unsatisfactory, do you mean the results were inconclusive or that they were not able to collect sufficient cells to make a determination?

While your nodule is suspicious and merits further evaluation, it is also just barely big enough to meet the size criteria for biopsy. So, the doctors may want to give it a month or two to see if it grows a bit and would make the biopsy more effective (not to mention easier!). Or, it could just be a scheduling issue...it often takes six to eight weeks to get into a specialist.

Yes, a single, hypoechoic nodule with calcifications are worrisome, but I hadn't heard the 96% stat. Remember that thyroid cancer is usually quite slow growing (my surgeon told me he thought my cancerous nodules were probably growing for ten years), so while, yes, you want treatment, there's usually less of a rush than with other cancers. That said, they usually treat men a bit more aggressively than women, so definitely get that second FNA!

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Ulfilas

Discussion Starter · #3 · Apr 14, 2013

Thank you so much for your response, joplin1975! They said the sample was unsatisfactory, in that they didn't collect enough cells to determine malignant/benign. I do know the wait time isn't a scheduling issue, because the doctor told me to only schedule it for 6-8 weeks from then (it's with a completely different group from hers that only does radiological testing). But perhaps your idea about seeing if it changes/grows could be it. I wondered if it wasn't something about trying to let the biopsy area "heal" first or something. When I talked to the doctor I just didn't think to ask--I was so disappointed I'd have to get another FNA.

Also thanks for the info about how slow growing it may be if it is indeed cancer. That puts my mind at ease

.

If you have a chance, check out the PDF I linked to in the original--it's a fascinating look at to what degree the likelihood of cancer can be anticipated just via the ultrasound. It's from a slideshow, and pretty quick to read and surprisingly easy to understand, as she explains things in layman's terms for the most part. It's only a few years old I believe so likely still valid, and by a respected researcher. She finds that microcalcifications alone give a "specificity" of 90% for cancer (i.e., there is a 90% chance that, if microcalcifications are present it is cancer); being "hypoechoic" alone is only a 53% specificity; but the two together are marked as 96% specificity. (I was glad she explained "sensitivity vs specificity" as I had seen that elsewhere and did not understand the difference.) Another study I read (see abstract here http://www.ncbi.nlm.nih.gov/pubmed/12112538 ) also mentions the high risk with microcalcifications.

In any case, I really appreciate your feedback!! It makes me much less nervous about the wait (I scheduled the procedure for 5/28...hoping they will evaluate on site though as they claim to do, since I don't really want to have to have a 3rd).

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