Endocrine

, Volume 45, Issue 1, pp 79–83 | Cite as

Patient’s comfort with and tolerability of thyroid core needle biopsy

  • Naim Nasrollah
  • Pierpaolo Trimboli
  • Fabio Rossi
  • Stefano Amendola
  • Leo Guidobaldi
  • Claudio Ventura
  • Riccardo Maglio
  • Giuseppe Nigri
  • Francesco Romanelli
  • Stefano Valabrega
  • Anna Crescenzi
Original Article

Abstract

Recently, the core needle biopsy (CNB) has been proposed as a complementary test for thyroid nodules with inconclusive cytology by fine-needle aspiration (FNA). However, there have been no reports regarding patient comfort during and after CNB or tolerability of this procedure. Here we aimed to investigate and compare comfort with and tolerability of the CNB and FNA procedures. A 21 gauge needle was used for collection in CNB procedures, and a 23 gauge needle was used for collection in FNA procedures. Sixty-one consecutive patients underwent both biopsies and were asked to evaluate their comfort during and after these procedures by a structured questionnaire. A total of 58 (95 %) patients reported local pain during both biopsies. Two patients reported pain only during CNB, and one reported no pain. Mild pain was reported in 87 % of CNB cases. Local pain after biopsy was reported in 29 % of FNA and 45 % of CNB. The occurrence of pain in the first minutes following CNB was significantly higher than FNA (p = 0.008), while there was not a significant difference in pain at later time points after the procedures. Finally, patients were asked to evaluate the degree of tolerability of the two sampling techniques, and FNA and CNB were reported as tolerable in 82 and 83 %, respectively. The results from a questionnaire evaluating patients’ comfort level showed no significant difference between the tolerability of CNB and FNA. This finding suggests that CNB may be performed with a reasonable level of patient comfort.

Keywords

Thyroid Core needle biopsy (CNB) Fine-needle aspiration (FNA) Comfort Tolerability 

References

  1. 1.
    H. Gharib, E. Papini, R. Paschke, D.S. Duick, R. Valcavi, L. Hegedüs, P. Vitti, AACE/AME/ETA Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. Endocr. Pract. 16, 468–475 (2010)PubMedCrossRefGoogle Scholar
  2. 2.
    H. Gharib, J.R. Goellner, Fine-needle aspiration biopsy of thyroid: an appraisal. Ann. Intern. Med. 118, 282–289 (1993)PubMedCrossRefGoogle Scholar
  3. 3.
    B. Hamberger, H. Gharib, L.J. Melton 3rd, J.R. Goellner, A.R. Zinsmeister, Fine-needle aspiration biopsy of thyroid nodules. Impact on thyroid practice and cost of care. Am. J. Med. 73, 381–384 (1982)PubMedCrossRefGoogle Scholar
  4. 4.
    Lee, Y.J., Kim, D.W., Jung, S.J.: Comparison of sample adequacy, pain-scale ratings, and complications associated with ultrasound-guided fine-needle aspiration of thyroid nodules between two radiologists with different levels of experience. Endocrine 2013. doi:10.1007/s12020-013-9906-1
  5. 5.
    D.W. Kim, M.H. Rho, K.N. Kim, 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. 10, 441–446 (2009)PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    S.A. Polyzos, Clinical complications following thyroid fine-needle biopsy: a systematic review. Clin. Endocrinol. (Oxf). 71, 157–165 (2009)PubMedCrossRefGoogle Scholar
  7. 7.
    S.A. Polyzos, Systematic review of cases reporting blood extravasation-related complications after thyroid fine-needle biopsy. J. Otolaryngol. Head Neck Surg. 39, 532–541 (2010)PubMedGoogle Scholar
  8. 8.
    L. García-Pascual, M.J. Barahona, M. Balsells, C. del Pozo, J. Anglada-Barceló, J. Casalots-Casado, E. Veloso, J. Torres, Complex thyroid nodules with nondiagnostic fine needle aspiration cytology: histopathologic outcomes and comparison of the cytologic variants (cystic vs. acellular). Endocrine 39, 33–40 (2011)PubMedCrossRefGoogle Scholar
  9. 9.
    M.F. Inci, F. Ozkan, M. Yüksel, I. Salk, M. Sahin, The effects of sonographic and demographic features and needle size on obtaining adequate cytological material in sonography-guided fine-needle aspiration biopsy of thyroid nodules. Endocrine 43, 424–429 (2013)PubMedCrossRefGoogle Scholar
  10. 10.
    Tutuncu, Y., Berker, D., Isik, S., Akbaba, G., Ozuguz, U., Kucukler, F.K., Göcmen, E., Yalcın, Y., Aydin, Y., Guler, S.: The frequency of malignancy and the relationship between malignancy and ultrasonographic features of thyroid nodules with indeterminate cytology. Endocrine 2013. doi:10.1007/s12020-013-9922-1
  11. 11.
    K.T. Park, S.H. Ahn, J.H. Mo, Y.J. Park, J. Park, S.I. Choi, S.Y. Park, Role of core needle biopsy and ultrasonographic finding in management of indeterminate thyroid nodules. Head Neck 33, 160–165 (2011)PubMedCrossRefGoogle Scholar
  12. 12.
    S. Zhang, M. Ivanovic, A.A. Nemcek Jr, D.V. Defrias, E. Lucas, R. Nayar, Thin core needle biopsy crush preparations in conjunction with fine-needle aspiration for the evaluation of thyroid nodules: a complementary approach. Cancer (Cancer Cytopathology) 114, 512–518 (2008)Google Scholar
  13. 13.
    J.Y. Sung, D.G. Na, K.S. Kim, H. Yoo, H. Lee, J.H. Kim, J.H. Baek, Diagnostic accuracy of fine-needle aspiration versus core-needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort. Eur. Radiol. 22, 1564–1572 (2012)PubMedCrossRefGoogle Scholar
  14. 14.
    D.G. Na, J.H. Kim, J.Y. Sung, J.H. Baek, K.C. Jung, H. Lee, H. Yoo, Core-needle biopsy is more useful than repeat fine-needle aspiration in thyroid nodules read as nondiagnostic or atypia of undetermined significance by the Bethesda system for reporting thyroid cytopathology. Thyroid 22, 468–475 (2012)PubMedCrossRefGoogle Scholar
  15. 15.
    A.E. Samir, A. Vij, M.K. Seale, G. Desai, E. Halpern, W.C. Faquin, S. Parangi, P.F. Hahn, G.H. Daniels, Ultrasound-guided percutaneous thyroid nodule core biopsy: clinical utility in patients with prior nondiagnostic fine-needle aspirate. Thyroid 22, 461–467 (2012)PubMedCrossRefGoogle Scholar
  16. 16.
    Nasrollah, N., Trimboli, P., Guidobaldi, L., Cicciarella Modica, D.D., Ventura, C., Ramacciato, G., Taccogna, S., Romanelli, F., Valabrega, S., Crescenzi, A.: Thin core biopsy should help to discriminate thyroid nodules cytologically classified as indeterminate. A new sampling technique. Endocrine 43, 659–665 (2013)Google Scholar
  17. 17.
    Yunker, W.K., Hassan, S.F., Ferrell, L.B., Hicks, M.J., Giannoni, C.M., Wesson, D.E., Cassady, C.I., Hernandez, J.A., Brandt, M.L., Lopez, M.E.: Needle core biopsy in the diagnosis of pediatric thyroid neoplasms: a single institution retrospective review. Pediatr. Surg. Int. 2013. doi:10.1007/s00383-013-3278-8
  18. 18.
    A. Carpi, A. Sagripanti, A. Nicolini, S. Santini, E. Ferrari, R. Romani, G. Di Coscio, Large needle aspiration biopsy for reducing the rate of inadequate cytology on fine needle aspiration specimens from palpable thyroid nodules. Biomed. Pharmacother. 52, 303–307 (1998)PubMedCrossRefGoogle Scholar
  19. 19.
    Q. Liu, M. Castelli, P. Gattuso, R.A. Prinz, Simultaneous fine-needle aspiration and core-needle biopsy of thyroid nodules. Am. Surg. 61, 628–632 (1995)PubMedGoogle Scholar
  20. 20.
    A. Gursoy, D.T. Ertugrul, M. Sahin, N.B. Tutuncu, A.N. Demirer, N.G. Demirag, The analgesic efficacy of lidocaine/prilocaine (EMLA) cream during fine-needle aspiration biopsy of thyroid nodules. Clin. Endocrinol. (Oxf) 66, 691–694 (2007)CrossRefGoogle Scholar
  21. 21.
    A. Gursoy, D.T. Ertugrul, M. Sahin, N.B. Tutuncu, A.N. Demirer, N.G. Demirag, Needle-free delivery of lidocaine for reducing the pain associated with the fine-needle aspiration biopsy of thyroid nodules: time-saving and efficacious procedure. Thyroid. 17, 317–321 (2007)PubMedCrossRefGoogle Scholar
  22. 22.
    T. Hor, S.W. Lahiri, Bilateral thyroid hematomas after fine-needle aspiration causing acute airway obstruction. Thyroid. 18, 567–569 (2008)PubMedCrossRefGoogle Scholar
  23. 23.
    C. Tomoda, Y. Takamura, Y. Ito, A. Miya, A. Miyauchi, Transient vocal cord paralysis after fine-needle aspiration biopsy of thyroid tumor. Thyroid. 16, 697–699 (2006)PubMedCrossRefGoogle Scholar
  24. 24.
    Y.S. Lee, H.S. Baek, T.S. Park, H.Y. Jin, Bilateral intrathyroidal hemorrhage after fine needle aspiration completely resolved by compression without thyroidectomy. Endocrine 43, 460–461 (2013)PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Naim Nasrollah
    • 1
  • Pierpaolo Trimboli
    • 2
  • Fabio Rossi
    • 2
  • Stefano Amendola
    • 2
  • Leo Guidobaldi
    • 3
  • Claudio Ventura
    • 2
  • Riccardo Maglio
    • 4
  • Giuseppe Nigri
    • 4
  • Francesco Romanelli
    • 5
  • Stefano Valabrega
    • 4
  • Anna Crescenzi
    • 3
  1. 1.Section of SurgeryOspedale IsraeliticoRomeItaly
  2. 2.Section of Endocrinology and DiabetologyOspedale Israelitico di RomaRomeItaly
  3. 3.Section of PathologyOspedale IsraeliticoRomeItaly
  4. 4.Department of Surgical and Medical ScienceSapienza UniversityRomeItaly
  5. 5.Department of Experimental MedicineSapienza UniversityRomeItaly

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