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COVID-19 and Thyroid Cancer: National Guidance on Fine-Needle Aspiration Biopsy

By: Julia Fiederlein
Posted: Friday, May 22, 2020

Sherman M. Harman, MD, of Phoenix VA Healthcare System, and colleagues hosted a multidisciplinary meeting to propose strategies for the optimal management of patients with thyroid nodules and thyroid cancer who may require fine-needle aspiration (FNA) biopsies during the COVID-19 pandemic. The guest editorial, published in Clinical Thyroidology, provide suggestions to preserve resources and prevent exposure while maintaining high-quality care.

According to the authors, patients with differentiated thyroid cancer generally have an excellent prognosis and a low mortality rate. They noted there is no clear association between early detection and improved outcomes. The authors suggested that FNA biopsies should be currently postponed for patients who present with asymptomatic thyroid nodules. Ultrasound results should be considered; however, they should not be the sole justification for performing a FNA biopsy or surgery.

Early diagnosis and surgical intervention significantly improve outcomes for patients with medullary thyroid cancer. Rather than performing FNA biopsy, the authors recommended calcitonin levels be assessed in patients with suspected medullary thyroid cancer. Patients with serum calcitonin levels above 10 pg/mL should be offered FNA; however, the authors proposed that patients with significantly elevated serum calcitonin levels should bypass this procedure and be considered for surgery.

In general, patients with anaplastic thyroid cancers warrant immediate surgical intervention. Those with suspected anaplastic thyroid cancer may undergo FNA biopsy at the discretion of the physician; however, they should be referred to a thyroid surgeon. Patients with thyroid masses causing compressive symptoms should also be offered surgical consultation, with or without prior FNA biopsy.

“During the pandemic, we believe the vast majority of thyroid FNAs should be considered optional, and [the] extent of surgery can be determined by pathological analysis of frozen sections intraoperatively,” the authors remarked.

Disclosure: For full disclosures of the study authors, visit liebertpub.com.

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