Keith Forwith

Innovative Thyroid Surgeon

What To Expect On An FNA

FNA is the best way to determine without a surgical procedure whether a nodule is benign or cancerous. It is done in the office setting under ultrasound guidance. Here are several things to be aware of:

  • Tell your doctor about any medications you are on. While patients on blood thinners may have excessive bruising from the procedure, blood thinning medications do not typically need to be stopped prior to the biopsy. Ask your doctor specifically whether these medications should be withheld. In most cases, this is typically not necessary.
  • You do not need to refrain from eating or drinking normally prior to the procedure.
  • After the procedure, you should be able to go back to your normal daily activities with no restrictions.
  • You should wear clothes that allow for the doctor to easily access the low part of the neck where the thyroid resides. Turtlenecks or high riding sweaters are not ideal. Many types of physicians perform FNA biopsies including endocrinologists, internists, pathologists, radiologists, and other physicians who have learned to perform an FNA. However, quality of the FNA is highly determined by the person taking the sample. As a thyroid surgeon, no one is more interested in an accurate diagnosis than I am and that is why I prefer to do my own needle biopsies to ensure that we get the best possible results!
  • The fine needle aspiration uses a very small needle that is typically much smaller than the one that is used to draw blood. There is minimal swelling, aching, or bruising in patients who are not on blood thinners.
  • Ask if you will be adequately numbed! While some people do not use numbing anesthesia prior to biopsy, I have found through my own experience and the experience of thousands of patients that people are way more comfortable if we do a very short injection and give adequate time for anesthetic effect. I cannot think of a single patient who would want to repeat a non-anesthetized FNA.
  • The optimal position for the FNA is lying down on the back with the neck slightly extended. A pillow is typically placed under the shoulder blades to fully expose the thyroid and allow for optimal biopsy.
  • After you are numb, the needle will be inserted, but typically patients do not feel the needle penetrating the skin. Breathing normally during the procedure helps to alleviate anxiety and as the thyroid moves up and down with swallowing and talking, typically we would ask you not to swallow or talk while we are taking the samples.
  • While the whole procedure may take 30-45 minutes, the needle stick portion of it only lasts a few seconds and involves just an odd pressure sensation when being performed.
  • After the procedure, the numbing medicine often can do some unusual things when it wears off. It is not unusual for people to get a pins and needles type sensation that can be felt in the ear or in the jaw. This is a referred sensation and it happens because of a nerve from the area of the neck hooking up in the same part of the brain as a nerve from the jaw or ear. This goes away as the medicine wears off and is no cause for concern.
  • Our FNA samples are sent to one of the most experienced labs in the country. There are quality differences in cytology readings and experience is critical for proper test results. This typically takes about a week to get results back. If molecular testing is indicated, this can delay results for up to three to four weeks.
  • While some doctors may give results over the phone, I do not find this to be a good practice. The purpose of sitting down with the patient to review the results is to go over best treatment advice and recommendations. This is true regardless of whether the biopsy is benign or cancerous. This is an excellent visit to bring a friend, spouse, or trusted companion as two sets of ears are often better at listening than just one.

This visit can also be effectively done via Telemedicine, which provides at home or work convenience.