Professor Department Otolaryngology University of Washington University of Washington Medina, Washington
Introduction:I The incidence of thyroid nodules in increasing in children. As with adults, the most effective way to make a diagnosis of a pediatric thyroid nodule is with an ultrasound guided fine needle biopsy. The standard practice in pediatric institutions is to perform biopsies under general anesthesia in the operating room. At our institution we are able to perform 85% of biopsies in clinic awake with local anesthesia.
IMethods:I This is a video presentation for the "Master" category demonstrating our approach at Seattle Children's. When new patients are referred to our "nodule" pathway, we review the ultrasound and obtain a TSH and free T4. If the nodule is not hyperfunctioning and meets ultrasound guidelines for biopsy, we schedule a clinic biopsy and ask families to review our YouTube introductory video. An entry point is marked with ultrasound and anesthetized with J-tip needleless buffered lidocaine syringes. With ultrasound guidance, a small amount of lidocaine is infiltrated down to the thyroid capsule. The lesion(s) is then biopsied usually with 25 gage needles in multiple locations. Pathology technicians assist in slide preparation.
IResults: IWe are able to biopsy 85% of nodule referrals awake in clinic (down to age 7). Exceptions can include trisomy 21, autism or PTEN patients. Our specificity and sensitivity for diagnosing papillary carcinoma matched to surgical pathology results is over 90%, the same as in adult series.
IConclusion:I In an age of increasing resource scarcity and increasing healthcare expense, it is valuable to be able to perform the large majority of thyroid nodule biopsies in clinic. This pathway also expedites the timing of diagnosis.