Assessment of pain score and specimen adequacy for ultrasound-guided fine-needle aspiration biopsy of thyroid nodules

Abstract

ObjectiveThe aim of this study was to evaluate pain scores and specimen adequacy for ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules without and with local anesthesia (LA).Materials and methodsThe US-FNAB procedure was performed on 183 patients with and without LA. One puncture was made for solid nodules, and if patients could tolerate it, a two-puncture technique was used for nodules with a cystic change. Four-point verbal rating scores were assessed by a nursing assistant after completion of US-FNAB. To be an adequate specimen, at least six groups of follicular cells are required, and each group should contain at least 10 cells.ResultsImmediately after US-FNAB, 92% of patients with LA and 80% without LA reported no or mild pain (p=0.01). Most patients tolerated the procedure well, with no pain (82.5%) reported 5 minutes after the procedure. In univariate logistic regression, irregular boundary (odds ratio [OR]: 2.52, 95% confidence interval [CI]: 1.04–6.06, p=0.04), calcification (OR: 2.86, 95% CI: 1.06–7.76, p=0.04), and LA (OR: 0.35, 95% CI: 0.15–0.86, p=0.02) were significantly associated with immediate moderate or severe pain. Specimen adequacy was significantly associated with age (OR: 0.95, 95% CI: 0.92–0.97, p<0.01), heterogeneous echo-texture (OR: 1.76, 95% CI: 1.23–5.17, p=0.01), predominate solid architecture (OR: 2.78, 95% CI: 1.42–5.41, p<0.01), and the use of LA (OR: 3.34, 95% CI: 1.70–6.56, p<0.01). In multivariate logistic regression, patients receiving LA had lower risk of moderate or severe pain (OR: 0.25, 95% CI: 0.09–0.67, p=0.01) and higher chances of specimen adequacy (OR: 4.84, 95% CI: 2.17–10.7, p<0.01) compared to patients who did not receive LA.ConclusionUS-FNAB is a safe procedure, and most patients report no pain 5 minutes after the procedure. The use of LA was associated with lower immediate pain scales and higher specimen adequacy.

Current Salivary Glands Biopsy Techniques: A Comprehensive Review

“…The studies were from four categories: before-after (pre-post) studies with no control group [ 15 , 16 , 17 , 18 , 19 ], observational cohort and cross-sectional studies [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ], systematic reviews and meta-analyses [ 42 , 43 , 44 , 45 , 46 , 47 ], and non-randomized studies [ 48 , 49 , 50 , 51 , 52 ].…”

“…It can also be performed during pregnancy, there are no contraindications, and anesthesia is not necessary because it would alter the sensitivity to palpation, reducing the accuracy of injection, it is also minimally invasive, quick to perform, and well tolerated by the patient [ 36 ]. The patient may experience occasional pain or discomfort in the postoperative period, rarely a subcutaneous hematoma may appear, and exceptionally a hemorrhagic effusion, organ damage, or surgical wound infection [ 30 ].…”

“…IOFSs represent an additional biopsy method to improve the diagnostic underperformance of US-FNAB, whose diagnostic outcome will guide the therapeutic strategy [ 47 ]. To quickly highlight the nature of the lesion and the completeness of the surgical excision, the anatomical piece is taken during surgery, subsequently placed in a special gel, frozen at -35°C, sections of few μm thickness are made, laid on a slide, and, finally, stained and analyzed under a microscope [ 30 ]. The sensitivity and specificity of IOFSs were found to be 80–90% and 98–99%, respectively, according to the study considered [ 31 , 41 ].…”

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

“…However, Gursoy et al 16 confirmed that a topical anesthetic cream could provide effective and non-invasive analgesia during FNAB of thyroid nodules. In addition, Liao et al 17 reported that the use of LA was associated with not only lower immediate pain scales but also higher specimen adequacy.…”

Use of the TI-RADS scoring system in the evaluation of thyroid nodules

“…Thyroid nodules are very common in the general population and can be found clinically in 4-7% of the general population. However, it seems that the true prevalence of thyroid nodules is higher (the prevalence is from 8 to 65% in autopsy and from 19 to 35% in ultrasound survey) [1,2]. Although most thyroid nodules are benign hyperplastic lesions, past research has determined that thyroid cancer occurs in 5 to 15% of thyroid nodules [3][4][5].…”