Office-Based FNA Thyroid Nodule Biopsies a Viable Option

Another code (76942) exists for using US to place the needle within the thyroid nodule, he added. The US-guided FNAB code and the needle placement code must be used for each nodule biopsied, not just for each patient, he explained.

What Patients Should Know

Overall, patients should know that US-guided FNAB is a safe procedure with very little risk, said Dr. Sofferman. With that said, they should be off blood thinners about five days before FNAB to limit the potential for hematoma, he added.

Fine-needle aspiration is not a very invasive procedure, said Dr. Terris. But there is always a chance of bleeding or infection, and blood may collect following the procedure. Dr. Terris also advises that patients don’t eat anything for a few hours beforehand.

When Referral May Be Necessary

Patients will need to be referred to radiologist if the office-based physician is not skilled or doesn’t have the necessary US equipment, said Dr. Sofferman.

Additionally, some lesions are difficult to sample, said Dr. Sofferman. For example, the neck may be scarred or the nodule may be resting on the carotid artery. Under these circumstances, the otolaryngologist who is not confident in US-FNAB may want to refer the patient to a radiologist or colleague with more experience, he said.

Required Skills and Experience

To perform US-FNAB well, the physician needs to have a certain skill set and qualifications, said Dr. Sofferman. You can’t buy and ultrasound machine and train yourself, he said.

The American College of Surgeons (www.facs.org ) offers a training and credentialing course on thyroid and parathyroid US, which includes biopsy instruction, at its annual congress, noted Dr. Sofferman, who chairs the training program.

The American Association of Clinical Endocrinologists (www.aace.com ) also offers a two-day accreditation course on thyroid US and FNAB.

Once physicians take a credentialing or accreditation course, they need to perform a number of cases under preceptorship, said Dr. Sofferman. How many US-guided FNABs need to be completed under this monitoring depends on the hospital requirements for credentialing of new procedures, he explained.

The bottom line is that people who are skilled in ultrasound-and this would usually be someone who does thyroid work and thyroid surgery-can perform US-guided FNA with high degree of efficiency at the office, said Dr. Sofferman. It doesn’t necessitate a separate trip to the radiologist.

©2008 The Triological Society