Contributors: Geoff Blair

Sedation is given even in youths as an FNA biopsy fully awake can be frightening for young patients and it affords a still target. An anesthetist is present to monitor and maintain the airway. A surveillance US is performed based on the images of the detailed previous US. In our institution and in many others the FNA biopsy is performed by qualified interventional radiologists as opposed to pathologists or pediatric surgeons. The field is prepped and draped. Local anesthesia, usually two percent lidocaine with epinephrine is injected with a small 25 gauge needle. The fine needle is then passed and seen on US to enter a solid component of the nodule to be biopsied. It is moved rapidly in and out and then swiftly aspirated to gather an appropriate sampling of cells. This is then expelled onto a waiting glass slides and spray fixative is applied. It is helpful to have the pathology technician on hand to ensure proper plating and fixation of the samples. US guidance may allow for a number of samples from different sites to be obtained safely. Biopsies of suspicious nodal tissue may be obtained as well in the same manner. Samples of nodal aspiration may also be sent for thyroglobulin determination; a marker of probable nodal thyroid carcinoma metastases. A simple bandage is applied at the needle entry sites and the child is allowed to recover from the procedure and sedative in a semisitting position to lessen the chances of postbiopsy bleeding. Discharge home within an hour or two is usual.