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Emory Abdominal Division Thyroid Biopsy GuidelinesSeptember 20, 2012

In conjunction with the Emory Departments of Otolaryngology andEndocrinology and based on SRU and ATA guidelines

Solitary Nodule in a Low RiskPatient

Reommendation

Microcalcifcations or signifcantlyhypoechoic

Strongly consider US-guided FNA i !1 cm

Solid "or almost entirely solid#isoechoic or hyperechoic, coarsecalcifcations

Strongly consider US-guided FNA i !1$% cm

Mi&ed solid and cystic or almostentirely cystic 'ith solid muralcomponent 'ith suspicious eatures in solidpart

'ithout suspicious eatures

(onsider US-guided FNA i ! 1$%-2cm(onsider US-guided FNA i ! 2 cm

Spongiorm (onsider US-guided FNA i ! 2 cm"although i truly honeycomb--ignore)#

None o the abo*e, but substantial

gro'th since prior US e&amination

(onsider US-guided FNA

Almost entirely cystic, none o abo*eand no substantial gro'th "or noprior US#

US-guided FNA unnecessary

+resence o abnormal lymph nodeso*errides US eatures o thyroidnodule"s#

US-guided FNA or biopsy o lymphnode

Solitary Nodule in a !i"h RiskPatient#

Reommendation

$ith suspiious %eaturessuch asmicrocalcifcations, signifcantly

hypoechoic, infltrati*e margins,"*ascular#

iopsy i % mm

.ithout suspicious eatures Follo' guidelines abo*e

*Risk factors:

Thyroid cancer in rst degree relati!eE"ternal #eam Radiation to nec$ or chest as a childE"posure to Ioni%ing Radiation as a child or adolescent&rior hemithyroidectomy with cancer'E()* familial medullary thyroid cancer+alcitonin ele!ation , -.. pg/ml0D12a!id on &ET scan

&ultiple Nodules with or without risk %ators

(onsider US-guided FNA o one or more nodules, 'ith selection prioriti/edon basis o criteria or solitary nodule "up to nodules in one session or perpatient tolerance#$FNA liely unnecessary in diusely enlarged gland 'ith multiple nodules osimilar US appearance 'ithout inter*ening normal parenchyma"3ashimoto4s or e&ample#$

'ther onsiderations

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5n an older66 patient 'ith stable non-suspicious or biopsy benign nodules or2 or more years consider cessation o imaging ollo'-up$5n an older66 patient 'ith nodules meeting si/e criteria or biopsy but noother criteria "no suspicious eatures# consider the ollo'ing 7although thenodule"s# meet si/e criteria or biopsy, it8they ha*e no suspicious eatures9consider one year US ollo'-up in lieu o biopsy$:

66older depends on age and co-morbidities$