One visit

Biopsy, read and consult

Results in 24 hours

Preliminary, not two weeks

No stitches

Local anesthesia only

Ultrasound guided

Straight to the nodule

First question

Most thyroid nodules are not cancer

Thyroid nodules are common. About half of adults have at least one by the age of sixty, and most are found by accident on a scan ordered for something else. Only 4 to 6 percent turn out to be malignant. Here is how a nodule worth watching differs from one worth sampling.

Common, benign findings

  • Colloid nodule. The most common kind by far. An overgrowth of normal thyroid tissue and storage protein, with no malignant potential.
  • Hashimoto’s thyroiditis. Autoimmune inflammation that leaves the gland lumpy and often underactive. Common, treatable, and not cancer.
  • Thyroid cyst. A fluid filled sac. Draining it during the aspiration often shrinks it on the spot.
  • Follicular adenoma. A benign tumor of thyroid cells. It can look identical to cancer on ultrasound, which is why the cells matter.

Worth sampling

  • It is larger than one centimeter. Most guidelines put the threshold for biopsy at 1 cm, and lower when the ultrasound looks suspicious.
  • The ultrasound looks suspicious. Microcalcifications, irregular margins, taller than wide, or increased blood flow inside the nodule.
  • It is growing. A nodule that has clearly enlarged between two scans deserves cells, whatever its size.
  • Hoarseness, a hard nodule, or a neck node. A voice change, a nodule fixed to the tissue around it, or an enlarged lymph node beside it.

None of these signs means cancer. They mean the nodule is worth sampling rather than watching. A fine needle aspiration answers the question in one appointment, which is a very different experience from waiting and wondering.

The reason to biopsy

What the cells can tell us

A thyroid fine needle aspiration is graded on the Bethesda system, the standard scale every cytopathologist uses. Under the microscope your nodule falls into one of three broad answers.

Not cancer

Benign

Bethesda II. Normal follicular cells and colloid in the proportions you would expect. This is the result for roughly seven in ten thyroid aspirations, and it is the answer most people come here hoping to hear. The usual next step is nothing more than a repeat ultrasound down the road.

Needs more information

Indeterminate

Bethesda III or IV. The cells are abnormal but not clearly malignant, most often a follicular lesion. Architecture rather than cell appearance separates benign from malignant in this group, so cytology alone cannot settle it. Molecular testing on the same sample or a surgical opinion comes next, and Dr. Nadelman explains which one fits your case.

Cancer of the thyroid

Papillary carcinoma

Bethesda V or VI. The majority of thyroid cancer is well differentiated, meaning it is highly treatable, and papillary thyroid carcinoma is by far the most common type. Finding it on a needle sample rather than after surgery is the entire point of the biopsy.

Two routes, same question

The difference is who reads your slides

In most of Los Angeles a thyroid nodule biopsy is a referral to a hospital radiology department. A radiologist takes the sample, and a pathologist you never meet reads it days later.

Standard referral

Two visits, two specialists

  • Day 0. Referral and imaging
  • Day 3. A radiologist takes the sample
  • Day 12 to 14. Pathology report reaches your doctor
  • If the sample is short. You find out two weeks later and start over

About two weeks of waiting

With Dr. Nadelman

One appointment

One visit, one specialist

  • Day 0. Ultrasound, biopsy, slides read on site, consultation
  • Same day. If the sample is short she knows immediately and takes another
  • Within 24 hours. Preliminary results to you and your doctor
  • No second trip. You talk to the person who made the diagnosis

An answer inside of two days

Your appointment

What actually happens

A fine needle aspiration uses a needle thinner than the one used to draw blood. There is no incision and there are no stitches. Plan on about an hour.

01

Consultation and ultrasound

Dr. Nadelman examines the nodule and looks at it on ultrasound first, so she knows exactly what she is sampling.

02

The aspiration

Local anesthesia, then a few passes with a fine needle. Most people find it easier than a blood draw.

03

Read on site

The slides are stained and examined in the office lab while you wait. This is the step that does not exist anywhere else.

04

You get answers

Preliminary findings usually within 24 hours, sent to whichever physician you name.

Celina-M-Nadelman-MD
Who reads your slides

Celina M. Nadelman, M.D.

One of very few physicians in the United States who is board certified in cytopathology and practices as a fine needle aspiration specialist. She performs the biopsy and she interprets it. There is no handoff.

  • Head of the FNA Clinic for Los Angeles County at the Martin Luther King, Jr. Outpatient Center
  • Clinical instructor, UCLA David Geffen School of Medicine
  • Co-Director of Pathology, Charles R. Drew University
  • Residency and fellowship at UCLA. M.D., Keck School of Medicine of USC

Waiting is the worst part. It does not have to take two weeks.

Next-day appointments are usually available, and house calls are available anywhere in California.

310.702.6701

1125 S. Beverly Drive, Suite 602
Los Angeles, CA 90035
Monday to Friday, 10 to 6

Before you call

Questions patients ask

Does a thyroid biopsy hurt?

Less than most people expect. The needle is thinner than the one used for a blood draw, the area is numbed first, and there is no incision, so there is nothing to stitch and nothing to heal. Most patients drive themselves home and go back to work the same day.

No. You can schedule directly with the office. If you do have a referring endocrinologist or primary care physician, Dr. Nadelman sends them the report and is glad to talk through the findings with them. Because she reads the slides herself, that conversation happens with the person who made the diagnosis.

It means the cells are abnormal but not clearly benign and not clearly malignant, which happens in a minority of thyroid aspirations. It is not a cancer diagnosis. Dr. Nadelman explains what the finding is, what the realistic odds are, and what the sensible next step looks like, whether that is molecular testing on the same sample, a repeat aspiration, or a surgical consultation.

Preliminary findings are usually available within 24 hours, because the slides are stained and read in the office rather than shipped to an outside lab. If the sample is inadequate she knows during your visit and takes another one, so you are not called back two weeks later to start over.