Do interventional radiologists (IRs) perform thyroid nodule biopsies?

From the Guidelines

Yes, interventional radiologists (IRs) commonly perform thyroid nodule biopsies, specifically fine-needle aspiration (FNA) biopsies, which are minimally invasive procedures used to collect tissue samples from suspicious thyroid nodules for pathological examination. These biopsies are typically performed under ultrasound guidance, allowing the interventional radiologist to precisely target the nodule while avoiding surrounding structures like blood vessels. The procedure involves inserting a thin needle through the skin into the thyroid nodule to extract cells for analysis. IRs are particularly well-suited for this procedure due to their expertise in image-guided interventions and their advanced training in ultrasound techniques.

Key Points to Consider

• Patients can expect the procedure to take approximately 20-30 minutes, with minimal recovery time and usually only mild discomfort that can be managed with over-the-counter pain relievers.
• While endocrinologists and head and neck surgeons may also perform thyroid biopsies, interventional radiologists often handle more complex cases or those requiring advanced imaging guidance.
• The most recent guidelines, such as those discussed in 1 and 1, emphasize the importance of standardized approaches to thyroid nodule management, including the use of Thyroid Imaging Reporting And Data Systems (TIRADS) for risk stratification and the consideration of fine-needle aspiration cytology (FNAC) for diagnosis.
• The management of "small" thyroid nodules (less than 1 cm) can be challenging due to conflicting recommendations among guidelines, highlighting the need for coordinated and standardized approaches to their management, as noted in 1 and 1.

Procedure Details

• The procedure is minimally invasive and typically performed on an outpatient basis.
• Local anesthesia may be used to minimize discomfort during the procedure.
• Patients are usually able to resume normal activities immediately after the procedure.
• Results from the biopsy are typically available within a few days to a week, depending on the laboratory and the complexity of the analysis.

Importance of Recent Guidelines

• Recent studies, such as 1 and 1, published in 2025, provide the most current insights into the management of thyroid nodules, including the role of interventional radiologists in performing biopsies.
• These guidelines emphasize the need for a multidisciplinary approach to thyroid nodule management, involving endocrinologists, surgeons, radiologists, and pathologists.
• The guidelines also highlight the importance of patient education and involvement in decision-making regarding the management of thyroid nodules.

From the Research

Interventional Radiologists and Thyroid Nodule Biopsies

• Interventional radiologists (IRs) do perform thyroid nodule biopsies, as evidenced by studies comparing the efficacy of different biopsy methods 2, 3.
• The role of IRs in thyroid nodule biopsies includes diagnostic procedures such as fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) 4, 5.
• IRs use ultrasound guidance to perform these biopsies, which helps to improve the accuracy of the procedure and reduce complications 3, 5.
• The studies suggest that IRs can perform thyroid nodule biopsies with a low non-diagnostic rate, especially with increasing experience 3.
• The use of ultrasound-guided FNAB and CNB by IRs can help to identify malignant nodules and reduce the need for unnecessary surgery 2, 6.

Biopsy Methods and Techniques

• Fine-needle aspiration biopsy (FNAB) is a common method used by IRs to diagnose thyroid nodules 2, 3, 6.
• Core needle biopsy (CNB) is also used, especially when FNAB is non-diagnostic or inconclusive 2, 5.
• Ultrasound guidance is used to perform these biopsies, which helps to improve the accuracy of the procedure and reduce complications 3, 5.
• On-site pathologist evaluation can help determine which patients need additional sampling 5.

Clinical Implications

• The use of thyroid nodule biopsies by IRs can help to reduce the rate of unnecessary thyroid surgery for patients with benign nodules 6.
• IRs play an important role in the evaluation and management of thyroid nodules, and their expertise can help to improve patient outcomes 4, 5.
• The studies suggest that IRs can perform thyroid nodule biopsies with a high degree of accuracy and safety, making them a valuable part of the multidisciplinary team involved in the management of thyroid nodules 2, 3, 5.