ULTRASOUND-GUIDED BIOPSY OF NONPALPABLE AND DIFFICULT TO PALPATE THYROID MASSES

We reviewed our experience with ultrasound-guided biopsies of masses o f the thyroid gland that were either nonpalpable or difficult to local ize by palpation to evaluate the technique and correlate the results. Thirty-two biopsies were performed upon 25 patients whose clinical pre sentations were palpable nodule (six patients), throat discomfort (two patients), postpartial thyroidectomy followup evaluation (two patient s), incidental discovery of a mass-by ultrasound of the neck (two pati ents), roentgenogram of the chest (two patients), computed tomography of the chest (one patient) and during tracheostomy placement (one pati ent). Other presentations were eliminate infection (one patient), odyn ophagia (one patient), hoarseness (one patient), cold nodule on a nucl ear medicine study (one patient), hyperparathyroidism (one patient), r ule out metastasis from carcinoma of the colon (one patient), persiste nt cough (one patient), enlarged thyroid gland (one patient) or family history of carcinoma of the thyroid gland (one patient). Fifteen pati ents had nuclear medicine studies showing either a cold nodule (ten pa tients), multinodular goiter (one patient), normal examination (two pa tients), hot nodule (one patient) or no thyroid gland activity (one pa tient). The ultrasound examinations showed either a hypoechoic nodule (25 patients), inhomogeneous or mixed echogenic nodule (six patients) or a hypoechoic nodule with hypoechoic rim (one patient). The nodules ranged in size from 3 milliliters to 7 centimeters. Twenty-six lesions were less than 3 centimeters in diameter; of the other six, four were substernal goiters. Six patients had a previous nondiagnostic biopsy directed by palpation only. Biopsy was performed using real-time ultra sound guidance with various needles. One patient had a small hematoma, which was the only complication in the study. The results of the biop sies were diagnostic in 26 of 32 patients. The final diagnosis was ben ign follicular cells (ten patients), adenomatous nodule (seven patient s), follicular neoplasm (three patients), colloid cyst (two patients), aspergillus (two patients), fibrosis (one patient) and papillary carc inoma (one patient). Six of the biopsies yielded unsatisfactory specim ens. One of the patients with a diagnosis of benign follicular cells o n biopsy had a follicular carcinoma after surgical pathologic factors were obtained; that was the only false-negative result. We conclude th at ultrasound-guided biopsy of the thyroid is a safe and useful method of evaluating nonpalpable and difficult to palpate thyroid masses.