BackgroundThyroid nodules are commonly encountered problems in clinical practice. For patients who have a thyroid nodule, the fine-needle aspiration biopsy (FNAB) is the most important test, as it is the most reliable diagnostic method for distinguishing between benign thyroid nodules and cancerous nodules. FNAB is able to be performed either via an ultrasound (USG) or alone and is the first choice when it comes to diagnosing thyroid nodules, given that it is cheap, safe and provides accurate results.ObjectiveIn this study-a retrospective analysis of FNAB via USG - our aim is to evaluate the multiple variables related to FNAB procedures, including the experience of the person performing the biopsy, the age and gender of the patient, the number of nodules, the size of the nodule(s) and the number of lams recorded from the cytopathology report on non-diagnostic rates, conducted at an invasive radiology clinic and at a general surgery clinic.Materials and methodsA total of 1062 patients involving 1869 nodules, examined using FNAB via USG, were reviewed retrospectively from records dated between November 2011 and July 2014 and from pathology reports taken from the ANEAH General Surgery clinic and Interventional Radiology clinic. Cytopathology results were classified according to the 2007 Bethesda System for Reporting. Gender, age, number of nodules, diameter of the nodules, biopsied nodules, location of the nodules, number of lams, symptoms and the date of biopsies were the parameters used to examine the factors involved in non-diagnostic cytopathology invasive radiology. These parameters were inspected at both of the clinics (ANEAH General Surgery clinic and Interventional Radiology clinic). In analyzing the results, the statistical significance level was set at 0.05, where in cases that the p value was under 0.05 (p < 0.05), it was determined that no significant relationship existed. In this study, data were analyzed using SPSS 20 software.ResultsOf the nodules reviewed, 1620 were found on females and 249 on males. The age of the patients ranged from 10 to 87 years, with the mean age being 50 years. In the general surgery clinic, 470 nodules of 341 patients were aspirated, and in the interventional radiological clinic, 1399 nodules of 721 patients were aspirated. In the literature review conducted to compare statistical assessments of FNAB via USG, no significant difference was found between the ANEAH General Surgery clinic and the Invasive Radiology clinic (p > 0.05). In the invasive radiology clinic, non-diagnostic rates decreased with the increase in experience of the person who conducted the biopsy (p = 0.001).ConclusionThe results from both of the clinic's rates of non-diagnostic FNAB, performed via USG, were found to be acceptable. Our study also demonstrates that USG-guided FNAB can be performed with a low non-diagnostic rate as experience grows.

Methodsby an interventional radiology expert. Subclavian vein was not preferred since it complicated the insertion of the catheter into the clavicle under ultrasound guidance. Adequate anesthesia was achieved prior to the procedure (1 μgr/kg fentanyl); sedation was ensured using midazolam (0,1 mg/kg) or ketamine (1-2 mg/kg). During the procedure, the patients were followed under continuous monitoring of the cardiac rate and rhythm, the respiratory rate and oxygen saturation. Except emergency situations, patients with pre-existing thrombocytopenia and abnormal coagulation test results were given supportive treatment and the catheter was inserted in these patients after the test results returned to normal. Central venous catheters were inserted by the pediatricians employed at the intensive care unit or interventional radiology expert at the pediatric intensive care unit. Double-lumen 4-Fr, triple-lumen 5-Fr, triple-lumen 7-Fr polyurethane transient catheters were used for patients with a body weight below 5 kg, between 5 and 20 kg and above 20 kg, respectively (Guangdong Baihe Medical Technology, China).For the purpose to recognize artery and vein; 1-the anatomic positions of internal jugular and femoral veins relative to arteries (internal jugular vein lies on the lateral side of the common carotid artery, femoral vein lies on the medial side of the femoral artery) (figure 1,2), 2-the compressibility of the internal jugular and femoral veins relative to arteries (figure 1,2), 3-in case of difficulty of discriminating the veins and arteries, the shape of the flow was investigated using Doppler mode of ultrasound (Figure 3). While transverse access was mostly used due to the size of the ultrasound probe, CVC was conducted using longitudinal access with real-time images in older patients (figure 4).Hand hygiene and aseptic conditions were ensured to manage infections. The site of administration was sterilized using 10% povidone iodine. A sterile ultrasound gel (Aquatouch Jelly, Turkey) and sterile transducer cover (Medbar Cardboard Camera Cover, Turkey) was used. While inserting the catheter, a "laptop style" ultrasound device and a straight linear probe (7.5 MHz) was used (Mindray-M5 Ultrasound System, China). The catheters were inserted using the Seldinger technique. The location of the catheter was assessed by posterior-anterior chest radiograph for the internal jugular catheters and the localization was deemed appropriate if the tip of the catheter was in the space between the distal part of vena cava superior and the entrance of the right atrium. Dressings were applied once every two days. Patients exhibiting the same microorganism growth in the catheter culture and the peripheral blood culture with accompanying the sepsis clinical findings and signs were diagnosed as central line-associated bloodstream infection while those with erythema, indurations and tenderness within 2 cm distance around the catheter exit were diagnosed with catheter exit-site infection 9 .