>> WHEN A PATIENT IS INITIALLY SEEN IN THE
THYROID CENTER, THERE ARE DIFFERENT DISCIPLINES WITHIN
CHOP THAT THEY COULD POTENTIALLY BE REFERRED TO.
>> WHAT WE TRY TO DO IN THE PROCESS WHEN THEY COME IN
IS GO OVER WHAT'S BEEN DONE, SEE WHAT QUESTIONS THAT THEY
HAVE, AND THEN TRY TO EDUCATE THEM ON WHAT THESE
THINGS COULD MEAN AND WHAT THE NEXT STEP IS
IN THE EVALUATION PROCESS.
>> A PATIENT WITH A THYROID NODULE REQUIRES A DIFFERENT
LEVEL OF CARE DEPENDING ON WHETHER OR NOT THE THYROID
NODULE HAS CHARACTERISTICS ON ULTRASOUND THAT LOOK LIKE
THEY COULD POTENTIALLY BE MALIGNANT.
>> ONE OF THE MOST IMPORTANT PARTS OF ADDRESSING ANY
THYROID NODULE IS TO MAKE SURE THE FAMILY UNDERSTANDS,
BY DEFINITION, HAVING A NODULE DOESN'T MEAN
THAT THIS IS ABSOLUTELY GOING TO BE MALIGNANT
OR IT REQUIRES SURGERY.
AND THAT'S PART OF THE REASSURANCE BECAUSE NOT ALL
NODULES ARE MALIGNANT.
AND ACTUALLY, MAJORITY OF NODULES TEND TO BE BENIGN.
>> IF THOSE NODULES ARE SOMETHING TO WORRY ABOUT
OR NOT THEN IS A MATTER OF EVALUATION.
>> THE FIRST THING THAT WILL HAPPEN IS THAT A PATIENT
WILL HAVE A THYROID ULTRASOUND,
WHICH IS AN ULTRASOUND OF THE GLAND ITSELF
AND THE REMAINDER OF THE NECK, LOOKING FOR THYROID
LYMPH NODES, LOOKING FOR OTHER LESIONS,
LOOKING TO SEE HOW BIG THE THYROID IS.
AND THAT IS PERFORMED BY OUR BODY IMAGING COLLEAGUES.
SO IF THE ULTRASOUND IS DEEMED APPROPRIATE
FOR A BIOPSY THEN THE PATIENT IS SCHEDULED
FOR AN ULTRASOUND-GUIDED FINE NEEDLE THYROID
ASPIRATION BIOPSY.
>> FINE NEEDLE ASPIRATION BIOPSY IS OUR WAY
OF DETERMINING IF THE CELLS WITHIN THE THYROID NODULE
APPEAR WORRISOME UNDER A MICROSCOPE.
>> THE IMPORTANT THING THAT WE HAVE IN PLACE WITH OUR
INTERVENTIONAL RADIOLOGISTS, WHO ACTUALLY PERFORM
THE FINE NEEDLE ASPIRATIONS, IT'S ALL DONE UNDER SEDATION.
SO THIS IS VERY CALMING FOR THE FAMILY.
>> THE SEDATION PHYSICIANS ARE ON-SITE.
THEY MEET THE FAMILY.
THEY COME UP WITH A SEDATION PLAN WITH THE FAMILY.
>> THE PATIENT HAS THAT EXPECTATION THAT THEY WILL
BE ASLEEP THROUGHOUT THE ENTIRE PROCEDURE.
WHAT THAT PROCEDURE INVOLVES IS A VERY FINE NEEDLE,
OR SMALL BORE NEEDLE, ADVANCED INTO THE LESION
OF QUESTION.
>> UNDER ULTRASOUND GUIDANCE,
SO THERE'S SOMEONE HOLDING AND LOOKING AT THE NODULE
AND CONFIRMING THAT THE NEEDLE IS GOING
INTO THE RIGHT LOCATION.
>> CELLS ARE OBTAINED THROUGH THE NEEDLE,
PLACED ON A SLIDE BY PATHOLOGY,
FOR REVIEW TO DETERMINE THE APPROPRIATENESS
OF THE SPECIMEN.
>> IT'S VERY IMPORTANT HAVING AN EXPERIENCED
PATHOLOGIST AVAILABLE AT THE TIME OF THE PROCEDURE, SO IN
REAL-TIME SHE CAN LOOK AT THAT MATERIAL AND TELL THE OPERATOR,
"YES, THIS IS GOING TO BE DIAGNOSTIC" OR
"NO, I DON'T THINK YOU'RE IN THE LESION" OR
"PERHAPS, WE SHOULD TAKE ANOTHER PASS."
>> WE GET VERY LITTLE TISSUE TO LOOK AT.
IT'S USUALLY A FEW CELLS.
BUT IN THE MAJORITY OF CASES,
THAT'S ENOUGH TO GIVE THE CONDITIONS AND INDICATION
AS TO WHAT THEY'RE DEALING WITH.
>> IF A NODULE IS MALIGNANT THEN THE CELLS THAT GET
REMOVED IN THIS PROCESS AND LOOKED AT UNDER
THE MICROSCOPE WILL REVEAL THE DIAGNOSIS.
>> THE PATIENT IS CONTACTED BY OUR THYROID TEAM
TO DISCUSS THE RESULTS.
>> SOMETIMES WE HAVE TO GO THROUGH THE FINE NEEDLE
ASPIRATION PROCESS TO PROVE THAT THIS NODULE
IS NOT MALIGNANT.
AND REALLY THEN, AT THAT POINT,
YOU KNOW THAT YOU HAVE THE REASSURANCE THAT THIS IS NOT
SOMETHING THAT THEN REQUIRES A FOLLOW-UP BY A SURGEON
AND FURTHER SURGICAL EVALUATION.
BUT AT THE SAME TIME, IF YOU HAVE A PATIENT WHO
HAS A THYROID NODULE WHO YOU KNOW BASED ON FINE NEEDLE
ASPIRATION IS MALIGNANCY, THEN YOUR NEXT STOP AS
THE PROVIDER, PRIOR TO SENDING THE PATIENT TO THE SURGEON,
IS TO MAKE SURE WHAT OTHER AREAS OF METASTASIS
CAN BE INVOLVED.
>> SO BECAUSE OF THAT WE MAKE SURE THAT WE HAVE
A STAGING ULTRASOUND PERFORMED BY ULTRASOUND
TECHS, READ BY RADIOLOGISTS, THAT ARE EXPERT AT DOING
THESE TYPES OF EXAMS, SO THE SURGEON KNOWS PRIOR TO
THE OPERATING ROOM WHAT TYPE OF PROCEDURE THEY'RE GOING
TO HAVE TO USE, AS FAR AS TREATMENT FOR THE PATIENT.