Japanese Journal of Radiology

, Volume 34, Issue 7, pp 503–507 | Cite as

How can we reduce the pain associated with FNA biopsy? Comparison of parallel and perpendicular method

  • Ihsan YuceEmail author
  • Mehmet Turkeli
  • Suat Eren
  • Akin Levent
  • Recep Sade
  • Mecit Kantarci
Original Article



To assess the tolerability of two different biopsy methods for thyroid nodules in a patient with nodular thyroid disease (NTD).

Materials and methods

The study included 58 consecutive patients who had NTD from June 2014 to October 2015. Each patient had, at least, two thyroid nodules were located in two lobes. Parallel and perpendicular fine-needle aspirations (FNAs) were performed.


The mean maximum diameters of the assessed thyroid nodules using ultrasound (US) in parallel and perpendicular techniques were 23 ± 7 and 22 ± 6 mm, respectively. Nodule sizes were not significantly different (p > 0.05). For the parallel and perpendicular techniques, the mean numeric rating scale (NRS), verbal rating scale (VRS), and visual analog scale (VAS) values were 3.6 ± 1.9, 2.6 ± 1.1, and 17.2 ± 13 with 6.6 ± 1.7, 3.4 ± 0.5, and 37.8 ± 18, respectively. All these values were statistically significant (p < 0.001); there were no statistical differences between females and males in terms of three pain scales (p < 0.001).


Patients experienced significantly less pain when undergoing FNA of NTD using the parallel technique as opposed to the perpendicular technique. Therefore, we believe that FNA using parallel technique is preferable for NTD patients.


Thyroid gland Biopsy Pain Parallel Perpendicular 


Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Brander A, Viikinkoski P, Nickels J, Kivisaari L. Thyroid gland: US screening in a random adult population. Radiology. 1991;181:683–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Carroll BA. Asymptomatic thyroid nodules: incidental sonographic detection. AJR Am J Roentgenol. 1982;138:499–501.CrossRefPubMedGoogle Scholar
  3. 3.
    Kim MJ, Kim EK, Park SI, Kim BM, Kwak JY, Kim SJ, et al. US-guided fine-needle aspiration of thyroid nodules: indications, techniques, results. Radiographics. 2008;28:1869–86.CrossRefPubMedGoogle Scholar
  4. 4.
    Yokozawa T, Miyauchi A, Kuma K, Sugawara M. Accurate and simple method of diagnosing thyroid nodules the modified technique of ultrasound-guided fine needle aspiration biopsy. Thyroid. 1995;5:141–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid. 1998;8:15–21.CrossRefPubMedGoogle Scholar
  6. 6.
    Rausch P, Nowels K, Jeffrey RB Jr. Ultrasonographically guided thyroid biopsy: a review with emphasis on technique. J Ultrasound Med. 2001;20:79–85.PubMedGoogle Scholar
  7. 7.
    O’Malley ME, Weir MM, Hahn PF, Misdraji J, Wood BJ, Mueller PR. US-guided fine-needle aspiration biopsy of thyroid nodules: adequacy of cytologic material and procedure time with and without immediate cytologic analysis. Radiology. 2002;222:383–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, et al. Assessment of pain. Br J Anaesth. 2008;101:17–24.CrossRefPubMedGoogle Scholar
  9. 9.
    Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain. 1995;61:277–84.CrossRefPubMedGoogle Scholar
  10. 10.
    Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4:407–14.CrossRefPubMedGoogle Scholar
  11. 11.
    Toman H, Ozkul F, Erbag G, Erbas M, Simsek T, Adam G, et al. Effects of fine-needle aspiration biopsy (FNAB) nodule depth on pain score. Ir J Med Sci. 2015. doi: 10.1007/s11845-015-1337-y.PubMedGoogle Scholar
  12. 12.
    Craig AD. Pain mechanisms: labeled lines versus convergence in central processing. Annu Rev Neurosci. 2003;26:1–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Meng Z, Lu G. Projection linkage from spinal neurons to both lateral cervical nucleus and solitary tract nucleus in the cat. Biol Signals Recept. 2000;9:38–44.CrossRefPubMedGoogle Scholar
  14. 14.
    Kim DW, Rho MH, Kim KN. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules: is it necessary to use local anesthesia for the application of one needle puncture? Korean J Radiol. 2009;10:441–6.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Gursoy A, Ertugrul DT, Sahin M, Tutuncu NB, Demirer AN, Demirag NG. The analgesic efficacy of lidocaine/prilocaine (EMLA) cream during fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf). 2007;66:691–4.CrossRefGoogle Scholar

Copyright information

© Japan Radiological Society 2016

Authors and Affiliations

  • Ihsan Yuce
    • 1
    Email author
  • Mehmet Turkeli
    • 2
  • Suat Eren
    • 1
  • Akin Levent
    • 1
  • Recep Sade
    • 1
  • Mecit Kantarci
    • 1
  1. 1.Department of Radiology, School of MedicineAtaturk UniversityErzurumTurkey
  2. 2.Department of Medical Oncology, School of MedicineAtaturk UniversityErzurumTurkey

Personalised recommendations