Comparison of cytological adequacy and pain scale score in ultrasound-guided fine-needle aspiration of solid thyroid nodules for liquid-based cytology with with 23- and 25-gauge needles: a single-center prospective study

Needle size for thyroid fine needle aspiration cytology. A single institution experience

Background

Fine needle aspiration cytology (FNAC) is an invasive diagnostic technique which is widely used for the cytological diagnosis of thyroid nodules. This procedure is generally widely tolerated by patients, albeit often accompanied by local pain and discomfort. Despite various proposals of execution methods, no approach is universally accepted,especially regarding the size of the needle to be used for sampling. Needle gauge preferences vary across regions, with 25-gauge needles more common in Western countries and 22-gauge needles favored in Asian countries. Complications associated with larger needles have been studied but remain inconclusive.

Materials and methods

Over one year, we conducted 300 FNAC procedures under ultrasound guidance, employing both 22-gauge and 25-gauge needles. In no patient was local anesthesia performed before starting the procedure, which in all was performed by the same operator. Similarly the cytological examination of the material taken was performed by a single operator. Patients, 105 males and 195 females, were divided into two groups of 150 each based on the needle size used.

Results

Patients treated with 22-gauge needles reported higher levels of pain during the procedure and increased discomfort afterward. Similarly, a greater incidence of hematomas and vasovagal reactions was noted in this group. However, the cell sample obtained and diagnostic response rates were consistent across both groups.

Conclusion

On the basis of our observations we concluded that the size of the needle used is irrelevant for the purposes of the diagnostic result, as long as the procedure is performed by expert personnel. However, the 25-gauge needle is preferable because it's more tolerated and accepted by patients. Our results do not represent a single and conclusive verdict, but they could represent the starting point for further research.

Comparison of Cytological Adequacy between 23- and 25-Gauge in Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: A Single-Center Prospective Study

INTRODUCTION

Approximately 15% of fine-needle aspiration (FNA) of thyroid nodules are considered nondiagnostic. Several factors are potentially involved, including clinical and nodule features but also the gauge (G) of the needle used. However, few studies have compared the cytological adequacy obtained with different gauge needles and the data are controversial. We aimed to evaluate cytological adequacy results using 23- or 25-G needles.

METHODS

This study is an observational and prospective study of thyroid nodules submitted to ultrasound-guided FNA. The procedure was performed randomly using 23- or 25-G needles. The samples were reported by different cytopathologists who were blinded to the information of the gauge of the needle used. Statistical analysis was performed to compare cytological adequacy of FNA between the two groups.

RESULTS

A total of 177 thyroid nodules were included - 98 (55.4%) using 23-G and 79 (44.6%) using 25-G needles. The 23-G group presented a higher rate of cytological adequacy (69.4% [68/98] vs. 46.8% [37/79], p = 0.002). No differences were found between the two groups regarding patient or nodule characteristics. On logistic regression, 23-G needles correlated with better cytological adequacy (unadjusted OR 2.57 [95% CI: 1.39-4.77]), even after adjusting for nodule dimension, location, and type of cytology (slides +/- additional liquid-based cytology) (adjusted OR 2.44 [95% CI: 1.23-4.84]).

CONCLUSION

The gauge of the needle used was found to be an independent predictor of cytological adequacy, with 23-G needles providing more adequate samples. Further investigation is needed to confirm our results in order to stablish the optimal diagnosis technique.

Effect of needle gauge on pain and specimen quality of ultrasound-guided fine needle sampling without aspiration of the canine spleen

Modifications of splenic parenchyma are common ultrasonographic findings in dogs. Splenic fine needle aspiration (FNA) is a rapid, safe procedure, routinely performed in veterinary institutions. However, 22-gauge (G) needle usually reported is selected according to general practice and the most appropriate needle size to be used remains unclear. The aim of this prospective, single-center, methods comparison study was to assess the effect of needle size on cytologic specimens' evaluation and animal welfare during the procedure. Dogs underwent ultrasound-guided splenic FNA using 23, 25, and 27G needles. Needles were compared based on initial and then detailed cytologic evaluation. The initial evaluation assessed overall cellularity, cell preservation, hemodilution, and detailed cytologic evaluation referred to exhaustive splenic components. Welfare evaluation was performed based on a scoring system. A total of 54 dogs were included in this study with 54 of 54 welfare evaluations and 35 of 54 cytologic evaluations by one or two European College of Veterinary Clinical Pathology-certified cytologists. The final cytologic diagnosis was unchanged regardless of the needle size. For the initial evaluation, 23G needles provided significantly higher cellularity than the 27G needles. For detailed cytologic evaluation, only the richness in mesothelial cells and stroma was affected by needle size. Pain induced by the procedures was considered low using 23, 25, and 27G needles with the 27G needle producing the least adverse reactions. Findings from the current study supported using needle gauges smaller than the previously published standard 22G needle for spleen ultrasound-guided fine needle nonaspiration in dogs. Due to higher cellularity and lower pain scores, authors recommend the use of 23G needles with a nonaspiration technique.

A Comprehensive Assessment of the Harms of Fine-Needle Aspiration Biopsy for Thyroid Nodules: A Systematic Review

BACKGRUOUND

There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of FNAB.

METHODS

Studies related with the harms of FNAB were searched on MEDLINE, Embase, Cochrane library, and KoreaMed from 2012 to 2022. Also, studies reviewed in the previous systematic reviews were evaluated. Included clinical complications were postprocedural pain, bleeding events, neurological symptoms, tracheal puncture, infections, post-FNAB thyrotoxicosis, and needle tract implantation of thyroid cancers.

RESULTS

Twenty-three cohort studies were included in this review. Nine studies which were related with FNAB-related pain showed that most of the subjects had no or mild discomfort. The 0% to 6.4% of the patients had hematoma or hemorrhage after FNAB, according to 15 studies. Vasovagal reaction, vocal cord palsy, and tracheal puncture have rarely described in the included studies. Needle tract implantation of thyroid malignancies was described in three studies reporting 0.02% to 0.19% of the incidence rate.

CONCLUSION

FNAB is considered to be a safe diagnostic procedure with rare complications, which are mainly minor events. Thorough assessement of the patients' medical condition when deciding to perform FNABs would be advisable to lower potential complications.

Nondiagnostic Test Result Rates Following Thyroid Extra-Fine-Needle Aspiration

OBJECTIVES

The first Bethesda classification category of thyroid fine-needle aspiration biopsy (FNAB) is nondiagnostic (ND), which indicates that the specimen's cellularity is inadequate for evaluation. This work investigated the effect of needle diameter size on ND rates by comparing diagnostic outcomes of FNAB samples collected with 23-, 25-, and 27-gauge needles.

METHODS

This was a retrospective analysis of samples collected from patients undergoing FNAB between 2018 and 2021. It was conducted in an otolaryngology department in a university teaching hospital.

RESULTS

Of the 699 aspirations, 144, 335, and 220 were performed using 23-, 25-, and 27-gauge needles, respectively. ND rates increased significantly when using 27-gauge compared with 23- to 25-gauge needles (P = .002), and a significantly lower ND rate was found for the 25-gauge needle compared with the 27-gauge needle (P = .001). Furthermore, increased nodule size was associated with reduced ND rate (odds ratio, 0.801; 95% confidence interval, 0.691-0.929).

CONCLUSIONS

The 25-gauge needles are superior to 27-gauge needles in reducing ND rates of thyroid nodule FNAB specimens. Future prospective studies should be performed to confirm these findings.

Effect of local anesthesia on pain scale and specimen adequacy in fine-needle aspiration biopsy of thyroid nodules for liquid-based cytology

Fine-needle aspiration biopsy (FNAB) is a routine diagnostic test for thyroid nodules. The use of local anesthesia (LA) before the procedure is still controversial. This prospective study aimed to evaluate the degree of pain and specimen adequacy in liquid-based cytology (LBC) for FNAB of thyroid nodules with and without LA. A total of 100 consecutive patients with thyroid nodules who underwent FNAB with and without LA between January and December 2020 were included. Patients who received LA had a significantly lower immediate pain scale score (P = 0.01). Multivariate analysis demonstrated that no use of LA (odds ratio [OR] = 3.48, 95% confidence interval [CI] = 1.50-8.10, P = 0.004) and lesion abutting the trachea (OR = 6.14, 95% CI = 1.56-24.12, P = 0.009) were independently and significantly associated with pain degree immediately after FNAB. A higher proportion of patients who previously underwent FNAB thought that LA was helpful and should be performed prior to FNAB. However, the use of LA did not improve the specimen adequacy (P = 0.075). The results showed that administration of LA with a proper technique before ultrasound-guided FNAB might reduce immediate pain after the procedure, and patients may experience more pain when the aspirated nodules abut the trachea.

Comparison of Ultrasound-Guided Fine-Needle Cytology Quality in Thyroid Nodules with 22-, 23-, and 25-Gauge Needles

Objective

To compare the cytology quality of ultrasound-guided fine-needle biopsy in thyroid nodules with 22-, 23-, and 25-gauge (G) needles prospectively.

Methods

A total of 240 consecutive nodules underwent ultrasound-guided fine-needle aspiration (USG-FNA) and 240 nodules underwent ultrasound-guided fine-needle capillary (USG-FNC) were included in this prospective study from October 2014 to February 2016. Each nodule was sampled using 22 G, 23 G, and 25 G needle according to designed orders, and 1240 smears were finally obtained. Cytology quality was scored by a cytologist blinded to needle selection.

Results

In USG-FNA, the average scores and standard deviations were 5.50 ± 2.87 for 25 G needles, 4.82 ± 2.95 for 23 G needles, and 5.19 ± 2.81 for 22 G needles. In USG-FNC, the average scores and standard deviations of each group were 5.12 ± 2.69 for 25 G, 4.60 ± 2.90 for 23 G, and 4.90 ± 2.90 for 22 G needles. The specimen quality scores of 25 G group were significantly higher than that of 23 G group (P < 0.017) in both USG-FNA and USG-FNC. However, the differences were not statistically significant in nondiagnostic rate using different gauge of needles (P > 0.017 for all).

Conclusions

25 G needles obtained the highest scores of sample quality in thyroid FNA and FNC comparing with 22 G and 23 G needles. 25 G needle should be first choice of thyroid FNA and FNC in routine work.

The patient experience in a cytopathologist-performed ultrasound-guided fine needle aspiration clinic: potential complications and feedback

INTRODUCTION

The number of fine needle aspirations (FNAs) being performed by cytopathologists has been increasing in recent years. As the advantages of cytopathologist-performed FNAs such as more frequent sample adequacy, appropriate specimen triage for ancillary testing, and optimal turnaround time are recognized, little has been reported from the patient's perspective. This study aimed to characterize the patient experience in a cytopathologist-run FNA clinic.

MATERIALS AND METHODS

Patient responses were collected as part of routine post-procedure telephone follow-up. Patient demographics, clinical history, reported complications, general feedback, and procedural data were documented.

RESULTS

Of 303 patients, 126 (41.6%) were available for follow-up. One or more minor complications including pain or soreness, swelling, and bruising at the biopsy site was reported by 46 patients (36.5%). No patients required additional medical treatment. For the patients who were unavailable for telephone follow-up, review of medical records showed 158 (89.3%) had at least one subsequent clinical visit and 1 reported bruising at the FNA site. Overall, none of the 284 patients with available follow-up information reported any major complications related to the FNA procedure. All patients had a generally positive experience, specifically citing the cytopathology team's thorough explanation of the procedure, cytopathologist ability to address questions and concerns, and professionalism.

CONCLUSIONS

Overall, the patient experience at our cytopathologist-run FNA clinic was positive. Minor procedure-related complications were reported in a subset of patients. No major complications were recorded, underscoring the safety of this procedure.

Patient Discomfort in Relation to Thyroid Nodule Fine-Needle Aspiration (FNA) Performed with or without Parenteral and/or Topical Anesthetic

OBJECTIVE

There is much reported variation in the impact of local anesthesia on thyroid fine-needle aspiration (FNA) related discomfort. We compare patients undergoing thyroid FNA with subcutaneous injection or topical anesthetic to no anesthetic.

METHODS

We conducted a retrospective review of 585 sequential ultrasound guided thyroid FNA procedures in Mayo Clinic. Group 1 (n = 200), no anesthetic; Group 2 (n = 185), subcutaneous injection anesthetic; and Group 3 (n = 200), topical anesthetic. Patient demographics, number of FNA passes, needle gauge, and cytopathology were recorded plus a discomfort score (0 to 10) before and immediately post procedure in all 3 groups and peak discomfort during the FNA in Groups 1 and 2.

RESULTS

There were no differences among the 3 groups in age, sex, FNA sufficiency rate, cytopathology, and FNA passes number. There was no significant difference between Groups 1 and 2 in peak discomfort score during the FNA: 0 (45%, 42.2%), 1 to 2 (19%, 24.9%), 3 to 5 (23.5%, 20.5%), 6 to 8 (9.5%, 10.8%), 9 to 10 (3%, 1.6%), respectively. Discomfort score post procedure: 0 (78.5%, 77.8%, 53.5%), 1 to 2 (13%, 13%, 36.5%), 3 to 5 (7%, 7%, 9%), 6 to 8 (1.5%, 2.2%, 1%), 9 to 10 (0%, 0%, 0%) for groups 1, 2, and 3, respectively. There were no significant differences among the 3 groups for a discomfort score ≥3.

CONCLUSION

FNA associated patient discomfort was comparable during and after the procedure regardless of the use of anesthetic or the type utilized. Approximately 90% of patients experienced mild to moderate discomfort during the procedure. And 90% reported no more than a level 2 discomfort post procedure.

ABBREVIATIONS

End = endocrinology; FNA = fine-needle aspiration; MCF = Mayo Clinic Florida; MCR = Mayo Clinic Rochester.