Does Large Needle Aspiration Biopsy Add Pain to the Thyroid Nodule Evaluation?

Angelo Carpi,Giorgio Iervasi,Matteo Russo,Giuseppe Rossi,Andrea Nicolini,Jeffrey Mechanick,Anthony Wi Lo

doi:10.1371/journal.pone.0058016

Abstract

Thyroid large needle aspiration biopsy is disregarded because it is thought to be associated with pain. This is in contrast with our 32 years long experience. We surveyed reports of pain in patients examined with fine needle aspiration biopsy (78, 87.2% women, mean age 59 years) or FNAB+large needle aspiration biopsy (48, 87.5% women, mean age 60 years). Each patient was questioned regarding a) no unpleasant sensation (score “0”); b) unpleasant sensation (“1”); c) mild pain (no analgesic used; “2”); or d) pain (analgesic used; “3”). The mean size of the needle used was for FNAB 22.3±0.7 or 20.8±1 gauge in the fine needle aspiration or fine needle aspiration plus large needle aspiration biopsy group, respectively (p<.0001). The number of percutaneous punctures was higher in the fine needle aspiration plus large needle aspiration biopsy group. However, the pain score in the fine needle aspiration biopsy or fine needle aspiration biopsy plus large needle aspiration biopsy group was not significantly different. Large needle aspiration biopsy after fine needle aspiration biopsy does not add any discomfort or pain and therefore in light of the demonstrable benefits, should be included in clinical algorithms for the evaluation of thyroid nodules.

Highlights

Fine needle aspiration biopsy (FNAB) is the principal test in the preoperative selection of thyroid nodules [1]
This study evaluates whether large needle aspiration biopsy (LNAB) adds pain to the thyroid nodule evaluation
The size of the needle used for FNAB was significantly higher in the FNAB+LNAB group

Summary

Introduction

Fine needle aspiration biopsy (FNAB) is the principal test in the preoperative selection of thyroid nodules [1]. More recent clinical practice guidelines [4] regarding thyroid nodules confirmed that LNB is not recommended. As it turns out, clarifying the specific LNB procedure used may enhance the clinical algorithm for the evaluation of thyroid nodules. LNB provides tissue cylinders or fragments for conventional histological evaluation [5]. These techniques can be grouped into two methods defined as large needle cutting biopsy (LNCB; or coarse needle biopsy) or large needle aspiration biopsy (LNAB) [5]. The LNCB technique has been nearly abandoned because it requires a sterile environment [5]

Methods

Results

Conclusion