How Much Biopsy Cost ?

[mja1906]

I need to have a biopsy done on my gland, can anyone tell me approximately how much these are in private hospitals in Thailand? thanks

I have heard McCormick in Chiang Mai is good

[rak sa_ngop]

I had a FNA Fine Needle Aspiration carried out last week at the Bangkok Christian Hospital. Ultrasound guided FNA on a nodule in my thyroid gland

Cost:

Drugs 175 baht

Medical supplies 461

Investigation and Pathology 900

Ultrasound 800

Other medical service charges 100

Doctor Fees 2000

Total cost 4236 baht

Note this does not include the doctor consultation fee (about 600 baht each visit) before and after the procedure.

[mja1906]

I had a FNA Fine Needle Aspiration carried out last week at the Bangkok Christian Hospital. Ultrasound guided FNA on a nodule in my thyroid gland

Cost:

Drugs 175 baht

Medical supplies 461

Investigation and Pathology 900

Ultrasound 800

Other medical service charges 100

Doctor Fees 2000

Total cost 4236 baht

Note this does not include the doctor consultation fee (about 600 baht each visit) before and after the procedure.

Thank you, you're the only one who replied I'm not sure what FNA is, or if its the same thing as biopsy, but hopefully whatever I need doing will be around that price

I'm not sure if its my thyroid, as my GP in the UK just told me 'gland' its a lump on the left side of my neck and that she would refer me to a Ear/nose/throat specialist who should then do a biopsy

So as I'm back in Thailand now, I need to do this here, which will hopefully be quicker than doing it on the NHS in UK

[lopburi3]

If it is thyroid (and that is a common problem) the procedure cited is done by just using a fine (shot type) needle into several areas of the lump and tissue is then checked for suspect cancer cells. If they can not rule out cancer and treatment does not reduce the size an operation might be required to remove part/most/all but that is future planning and in my case cost about 100k in total. Believe most would use endocrinologist if really thyroid.

[Sheryl]

Wherever the "gland" is, biopsy will entail 2 main steps:

1. Removal of a sample of tissue

2. Inspection of the tissue by a pathologist

and there will be separate charges around these. #2 depending on the hospital, 1000 - 2000 baht if private hospital, maybe around 500 if a government hospital. #1 varies enormously depending on what has to be done to obtain the tissue (needle biopsy as opposed to surgery) as well as the doctor and hospital. Needle biopsy (FNA) is the least expensive and least invasive but not always posisble.

If it is the thyroid gland, I second Lopburi3's recommendation - be sure it is done by an endocrinologist specializing in thyroid disorders.

If you are in Chiang Mai, the least expensive option and also arguably the best quality (but not the greatest convenience) is Sri Pat, the semi-private oputpatient facility at CMU Hospital. Also called Suan Doc. It is a government teaching hospital so long waits and some red tape, but very reasonable cost and a good range of specialists including many Professors.

[chiang mai]

Dr Umpiga at Sri Pat comes highly recommended for all things thyroid related, Mondays only, 13th floor. Also, can recommend almost every aspect of Sri Pat Hospital, it's a lot more together than the larger private hospitals in Bangkok and the South - the Radiology doctors in particular, the folks who interpret x-rays and scans are truly top notch.

Edited October 26, 2011 by chiang mai

[mja1906]

Thanks all, just to update you - I'm not sure if I need to have a biopsy done any more ?

Basically the week before flying back to Thailand my GP in the UK said she would refer me to ENT specialist, who would probably then do a biopsy - which is why I thought I needed one done. I told her I would have it checked out in Thailand as that is where I live. So I went the ENT Dr. at Mission hosp in Phuket, when I told him my GP in the UK said I'd probably need a biopsy, he looked a little taken aback and smiled (as if that was an extreme measure to take). Then he said, cos my age (31) he said it was probably due to a bacterial infection of the throat (even though there are no symptoms, sometimes there can still by underlying bacteria present caused by for example a cold/sore throat from before that never fully cleared up).

Anyhows after 1wk course of antibiotics, the lump in my lymph nodes reduced to half the size (good news, as it was responding to antibiotics, so he said I prob would not need an operation). Then he put me on 5days more of antibiotics (which I have just finished, my the lump/swollen lymph glands still there however). I have another follow up with him this Friday, I wonder what he will say

1st visit to ENT Dr at Mission cost 800bt (including antibiotics),

2nd visit cost (600bt)

I can't comment on quality of hosp/service, as I don't really have anything else to compare to.

Although the reception area seemed pretty disorganised/chaotic with lots of people milling about and waiting.

Like many, I just have to trust what the Dr is saying/telling me. I am due to move back to Chiang Mai early Dec, so if still not happy with my gland situation might seek a 2nd opinion at SriPat

[Sheryl]

I assume you had the enlarged node(s) for a significant amount of time or your GP in the UK would not have talked of specialist & biopsy.

Unless it totally disappears with antibiotic therapy (which I doubt as surely that was already tried in the UK) a biopsy is the safest course of action. At worst, you spend some money unnecessarily, and at best, you save your life by getting a potentially fatal condition diagnosed in time.

Thai medical practice and practitioners tend to apply the "mai pen rai" attitude while the western motto is more like "better safe than sorry". Many (not all -- but many) Thai physicians also, in my experience, tend to discount anything that is unlikely/ not worry about comparatively small risks, whereas in the West we believe in taking appropriate measures to reduce risks, even small ones, and in making sure rather than assuming. After all, even if the odds of something are a hundred to one, that's no comfort if you turn out to be the unlucky one. Especially if the problem could have been prevented or cured in time.

If it were me, I'd get the biopsy. The fact that cancer is less common at your age doesn't make it impossible and the benefits of making sure far outweigh the expense/trouble.

[mja1906]

I assume you had the enlarged node(s) for a significant amount of time or your GP in the UK would not have talked of specialist & biopsy.

Unless it totally disappears with antibiotic therapy (which I doubt as surely that was already tried in the UK) a biopsy is the safest course of action. At worst, you spend some money unnecessarily, and at best, you save your life by getting a potentially fatal condition diagnosed in time.

Thai medical practice and practitioners tend to apply the "mai pen rai" attitude while the western motto is more like "better safe than sorry". Many (not all -- but many) Thai physicians also, in my experience, tend to discount anything that is unlikely/ not worry about comparatively small risks, whereas in the West we believe in taking appropriate measures to reduce risks, even small ones, and in making sure rather than assuming. After all, even if the odds of something are a hundred to one, that's no comfort if you turn out to be the unlucky one. Especially if the problem could have been prevented or cured in time.

If it were me, I'd get the biopsy. The fact that cancer is less common at your age doesn't make it impossible and the benefits of making sure far outweigh the expense/trouble.

Hi Sheryl, I really value your advice. You confirm what I suspected, and I would prefer to be safe than sorry. I have just finished a 12day antibiotic course, and whilst it is smaller it has not totally disappeared.

I think when I see the ENT on Friday I will insist on a Biopsy then. Thank you, so much

[lopburi3]

If using thin needle make sure the person doing is qualified - ENT is not likely to have done outside of training I suspect and the failure rate (for getting all types of cells) is very high for non experts. I just checked my bill from last year and total for visit/ultrasound/pathology was 3,000 baht at Vejthani (which is a higher priced private hospital - but lower than some of the better known). The discomfort is slight and only takes a few minutes time.

[mja1906]

If using thin needle make sure the person doing is qualified - ENT is not likely to have done outside of training I suspect and the failure rate (for getting all types of cells) is very high for non experts. I just checked my bill from last year and total for visit/ultrasound/pathology was 3,000 baht at Vejthani (which is a higher priced private hospital - but lower than some of the better known). The discomfort is slight and only takes a few minutes time.

Thanks Lopburi, so I need to ask for somebody who is qualified in using thin needle. How would one know, if they really are qualified? and were able to get all types of cells? (cos knowing the Thai response it would be don't worry he/she is qualified and I would just have to take their word for it)

I hope I can use thin needle then, and not surgery , as the latter would prob be more expensive

Does anyone how long it takes to get the results? Or may this vary, depending on the case?

[lopburi3]

It would be a specialist, endocrinology, and they should be able to say what percentage of there procedures are inconclusive (but as you say that is western thinking) so probably ask for the most experienced of nursing staff (out of earshot of doctors) is the best you can really expect to do.

Believe a few days are normal - can't really recall but believe I had week later appointment but doctor called after 4 days to advise nothing found (but I may be wrong on that - mind retention becomes less than ideal at multiples of your age).

[Sheryl]

Lop,

From isi descruioption, this is not a thyroid problem, it is a persistant enlargment of one of the lymph nodes on the side of the neck. So an endocrinologist would not be appropriate.

Mja,

what you need is an ENT specilaizing in head and neck surgery (don't freak out -- doesn't mean you need major surgery. just that these are the ones with the expertise to do a biopsy).

Lacking that, a general surgeon.

They may be able to do the procedure through FNA or it may need a small excision which can likely be done under local anesthetic.

Usually takes about a week to get the pathology report.

Not to scare you, but this isn't something to delay much on. You need to make sure the node is benign, or if it is not, find out exactly what it is so you can start appropriate treatment.

[chiang mai]

Lop,

From isi descruioption, this is not a thyroid problem, it is a persistant enlargment of one of the lymph nodes on the side of the neck. So an endocrinologist would not be appropriate.

Mja,

what you need is an ENT specilaizing in head and neck surgery (don't freak out -- doesn't mean you need major surgery. just that these are the ones with the expertise to do a biopsy).

Lacking that, a general surgeon.

They may be able to do the procedure through FNA or it may need a small excision which can likely be done under local anesthetic.

Usually takes about a week to get the pathology report.

Not to scare you, but this isn't something to delay much on. You need to make sure the node is benign, or if it is not, find out exactly what it is so you can start appropriate treatment.

Trying to find a Head and Neck Surgeon is really really difficult here and I speak from experience, many nurses at major hospitals believe such a person is a regular ENT doctor which of course they are not. I have one highly recommended reference in Singapore but none in Thailand, even at Sirpat in Chiang Mai, perhaps Sheryl or others can refer?

[mja1906]

Thanks, wow, you have certainly put a different spin on this for me. I will go and see the ENT Dr. tomorrow. So I should just tell him I'm not happy and demand a biopsy/operation?? (Whatever procedure I need to find out if its benign). And then would he refer me to a head/neck surgeon, or how???

[Sheryl]

I am doubtful about there being an ENT specializing in head & neck in Phuket. Most ENTs in Thailand specialize in allergic conditions, sinus problems etc. The nearest would likely be Surat Thani

A general surgeon or an oncologist may also be able to do this.

FYI there are 3 ways such a lymph node biopsy can be done;

fine needle aspiration (they insert a needle and aspirate a few cells)

core needle aspiration (same as above but bigger needle, easier to do)

open biopsy - they make a small cut and remove the lymph node altogether. This provides the largest sample for biopsy, but is the most invasive procedure.

All 3 are usually done under local anesthetic. Fine Needle Aspiration Biopsy (FNAB) is the preferred procedure. There are some risks associated with the other approaches and in cases where it does prove malignant, the best final outcome is when the initial biopsy was FNAB as the other approaches may inadvertently spread the cancer.

the whole thing is best overseen by a either a head & neck surgeon or an oncologist.

If you can travel for this (Singapore, KL or --depending on what the floods do -- Bangkok) it might be worth it.

Otherwise I suggest just insisting that you want a "fine needle aspiration biopsy" and ask for referral to a doctor experienced in doing FNAB of cervical lymph nodes. Firmly. If that doesn't work and you are not able to travel soon, see an oncologist. An oncologist will be best able to appreciate the need for it and, if not able to do the biopsy themselves, most likely to make an appropriate referral. There does not seem to be an oncologist at Mission Hospital. There is 1 at Bangkpk Phuket and at Phuket international clinic (2 different people, I have no feedback on either of them, but at least being oncologists they are unlikely to shrug of a persistantly enlarged lymph node).

[mja1906]

I am doubtful about there being an ENT specializing in head & neck in Phuket. Most ENTs in Thailand specialize in allergic conditions, sinus problems etc. The nearest would likely be Surat Thani

A general surgeon or an oncologist may also be able to do this.

FYI there are 3 ways such a lymph node biopsy can be done;

fine needle aspiration (they insert a needle and aspirate a few cells)

core needle aspiration (same as above but bigger needle, easier to do)

open biopsy - they make a small cut and remove the lymph node altogether. This provides the largest sample for biopsy, but is the most invasive procedure.

All 3 are usually done under local anesthetic. Fine Needle Aspiration Biopsy (FNAB) is the preferred procedure. There are some risks associated with the other approaches and in cases where it does prove malignant, the best final outcome is when the initial biopsy was FNAB as the other approaches may inadvertently spread the cancer.

the whole thing is best overseen by a either a head & neck surgeon or an oncologist.

If you can travel for this (Singapore, KL or --depending on what the floods do -- Bangkok) it might be worth it.

Otherwise I suggest just insisting that you want a "fine needle aspiration biopsy" and ask for referral to a doctor experienced in doing FNAB of cervical lymph nodes. Firmly. If that doesn't work and you are not able to travel soon, see an oncologist. An oncologist will be best able to appreciate the need for it and, if not able to do the biopsy themselves, most likely to make an appropriate referral. There does not seem to be an oncologist at Mission Hospital. There is 1 at Bangkpk Phuket and at Phuket international clinic (2 different people, I have no feedback on either of them, but at least being oncologists they are unlikely to shrug of a persistantly enlarged lymph node).

Thanks again Sheryl. So I went the ENT Dr today, and I insisted in having a biopsy (he still thought I was over reacting) so anyways. He has scheduled for me to have an ultra sound then xray tomorrow (apparently this is standard procedure before a biopsy to find out if its just one node or many, and rule out anything going on in the chest area). Then he said I could have an open biopsy on tues/wed. I asked about the fine needle, but he said they normally do open biops in this case (something about it being easier to get to or something).

Would they really remove the whole lymph node? I've never had an operation before, what kind of risk would be involved in this?

I'm surprised they don't even have 1 oncologist at Mission? I wonder if it would be better for me to see an Oncologist at Phuket International instead now, to have this done ?

[Sheryl]

I asked about the fine needle, but he said they normally do open biops in this case (something about it being easier to get to or something

I think this is code for "I don't know how to do it/we don't have anyone here who knows how to do it"

The OP & I are in touch now by PM so it may be a while but I expect he'll update all concerned readers once things are sorted out

[chiang mai]

Sheryl is the expert in these matters so you must follow her advice. I however have substantial experience of ENT at Bangkok/Phuket Hospital and frankly it is pretty hopeless for anything much more than a sore throat or blocked sinus or similar, they certainly do not have a Head and Neck Surgery expertise on staff or even on call - I would also seriously question their expertise in oncology although I cannot factually comment on this aspect. I would certainly support the idea of travel to Bangkok at a minimum in order to get this done. Also, you mention having an x-ray and ultrasound, did you mean to say an MRI scan?

Note: an FNA is a very straight forward and painless procedure that is over and done with in a couple of minutes.

[mja1906]

Sheryl is the expert in these matters so you must follow her advice. I however have substantial experience of ENT at Bangkok/Phuket Hospital and frankly it is pretty hopeless for anything much more than a sore throat or blocked sinus or similar, they certainly do not have a Head and Neck Surgery expertise on staff or even on call - I would also seriously question their expertise in oncology although I cannot factually comment on this aspect. I would certainly support the idea of travel to Bangkok at a minimum in order to get this done. Also, you mention having an x-ray and ultrasound, did you mean to say an MRI scan?

Note: an FNA is a very straight forward and painless procedure that is over and done with in a couple of minutes.

Thank you Chiang Mai. So you mean ENT at Bangkok hops/ PHuket International is pretty hopeless? I'm going to see an Oncologist at Phuket Intl tomorrow, will update you. The ENT dr. today definitely said ultra sound and x-ray. Not MRI

Don't suppose FNA in Chiang Mai is an option then?

[chiang mai]

Sheryl is the expert in these matters so you must follow her advice. I however have substantial experience of ENT at Bangkok/Phuket Hospital and frankly it is pretty hopeless for anything much more than a sore throat or blocked sinus or similar, they certainly do not have a Head and Neck Surgery expertise on staff or even on call - I would also seriously question their expertise in oncology although I cannot factually comment on this aspect. I would certainly support the idea of travel to Bangkok at a minimum in order to get this done. Also, you mention having an x-ray and ultrasound, did you mean to say an MRI scan?

Note: an FNA is a very straight forward and painless procedure that is over and done with in a couple of minutes.

Thank you Chiang Mai. So you mean ENT at Bangkok hops/ PHuket International is pretty hopeless? I'm going to see an Oncologist at Phuket Intl tomorrow, will update you. The ENT dr. today definitely said ultra sound and x-ray. Not MRI

Don't suppose FNA in Chiang Mai is an option then?

Once again, you must take your lead from Sheryl on this - but to answer your question about an FNA at Chiang Mai, yes indeed you could easily have that done here at either Sripat or RAM hospitals, preferably the former. As for the Phuket Hospitals: my comments were not about the International Hospital of which I have no experience. If I were you I would strongly consider Sripat in CM but you should see what Sheryl advises.

[cheeryble]

Thanks, wow, you have certainly put a different spin on this for me. I will go and see the ENT Dr. tomorrow. So I should just tell him I'm not happy and demand a biopsy/operation?? (Whatever procedure I need to find out if its benign). And then would he refer me to a head/neck surgeon, or how???

I hope your result shows benign.Sheryl is likely right but if it IS the thyroid and it needs taking out be aware that the main RAM guy will take out the whole thing based on "I had a bad experience once with taking half out". He was also very upset when I tried to check his experience in this particular area. I hope my next builder doesn't get upset when I ask him to show me somewhere he's done before.I ended up in Bumrungrad where I found Dr Watana's attitude far more intelligent. I told him what the Ram guy had said. "and I've had a lot of GOOD experiences" he said, explaining they followed the Mayo protocol of taking out half, doing an immediate check, then sewing you up and doing a full pathology overnight and opening up again if necessary (very rare). Well the Mayo's good enough for me.

So now I have half a thyroid which works perfectly well instead of being on thyroxine tabs and blood checks the rest of my life.

As the song says.....Don't worry, it really ain't worthwhile.....things work out all right but do what you got to do.

Cheeryble

Edited November 13, 2011 by cheeryble