Before you get too far into this, into a blog entry posted on a Web site called Diabetes Self-Management, please know that what follows has little to do with diabetes.
You may recall that two weeks ago I had a thyroid ultrasound (see both “Is It Just Always Something?” and “No Food or Drink Allowed”). That day, I was going to report on the experience of the ultrasound, but then the infamous “Don’t drink the fruit juice in here” incident came up, and I was compelled to share with you what I considered a diabetic slight.
But, the thyroid biopsy was itself rather uneventful. The nurse led me down one corridor, then past another waiting room, and then we turned and walked down a few more hallways before going into a rather large room in which I would have the biopsy performed.
When I thought about my biopsy prior to actually being in the hospital, I imagined that it would be a simple “lie back, we’re going to poke you a few times,” and then everything would be over. Instead, it was more like being present for a minor surgery, which it was.
Minor surgery is a vague term, I know. To me, surgery is the whole operating theater, see-it-on-TV drama, with blood and guts and beeping and machine noise, and lots of people standing around the operating table. For my biopsy, the minor surgical aspect was just that: a nurse, a doctor doing the biopsy, and an ultrasound representative (or some sort of someone like that; it was a new ultrasound interface, so this person was there to help the doctor navigate its new features).
The procedure came complete with my having to read and sign a consent form (“I’ll leave the room so you can read this and not feel pressured to sign”); sterile fields (“don’t bring your hands up into this area”); a good dollop and rub of cold iodine(ish) fluid to prep my skin; lots of “nurse I need a new set of gloves because I just touched…” (a) “the table,” or (b) “the cord,” or (c) “the screen,” or (d) “my gown”; as well as my being able to look over at the ultrasound screen and see the cystic mass that has grown on my thyroid, see the needles (six of them in total) going two inches into my neck, one by one, and then watching them move back and forth while the doctor palpated — kind of bounced the needle up and down — in and around the mass to get the fluid out for sampling, all the while my head experiencing this weird throbbing because my body was trying to interpret, but couldn’t, what was going on in my throat.
Not something that, in my book, I’d call simple. So I think minor surgery fits.
The treatment I received throughout this minor surgery was phenomenal, from my interaction with the nurse to the thoroughness of the doctor’s explanations of procedures and then his explanation of what he was doing as he performed the actual biopsy.
After the biopsy, the doctor then spent five minutes explaining the possible different results that I might receive when, in three to five business days, my doctor would have contacted me. There was, of course, the possibility of the diagnosis of cancer. Then there was its opposite diagnosis: no cancer.
And then…then there was this gray area, something called suboptimal, which he quickly prefaced by saying, “Don’t let this scare you” before proceeding to tell me about what suboptimal meant.
Guess which result came back?
Suboptimal diagnoses on thyroid biopsies are — if you ask me — pretty good news, all things considered.
Allow me to paraphrase some things from my doctor in what follows, as well as adding my own (and yeah, you won’t know exactly what text is mine and what’s hers, and I want it that way).
- The biopsy results showed nothing bad, but nothing entirely straightforward.
- The good news is that the biopsy did not show any evidence of cancer cells. There was a mixture of Hurthle cells, follicular cells, and colloid cells (you can do your own Googling of these types of cells if you’re curious).
- The not-quite-so-good news: The sample was, as I said, considered “suboptimal.” This means that the sample wasn’t adequate to make a definitive diagnosis, but this can be typical of lesions with a cystic component, which mine was.
- Lesions with a cystic component inherently have a lower risk of being something bad (read cancerous).
All in all, I’m satisfied. For now. I was prepared for this diagnosis, thanks to the doctor (the one who performed the biopsy) taking his time to explain this possibility to me the day of the biopsy. He even referred to a study that the University of Michigan Hospital conducted on over 500 patients with suboptimal returns on their thyroid biopsies. Over time, only 2% of those receiving suboptimal diagnoses developed cancer; and of those, the cancer that developed was the — and I forget the word he used for it here, so I’ll put in my own words — best kind to get…the type that’s easily and completely treatable.
What do I do now, then?
I have another thyroid ultrasound in six months (I’m already having a repeat ultrasound next year on my kidney for what they — doctors, again — want to confirm with the follow-up). Then, after the six-month thyroid ultrasound, follow-up ultrasounds every year.
This damned human body and its so many shades of gray. You’d think that with scientists and the billions of dollars that go toward figuring us out, there’d be something more conclusive. But no.
Ah, well. As is more-than-oft repeated in Vonnegut’s Slaughterhouse-Five, “So it goes…”