Skip to main content

Effects of fine-needle aspiration biopsy (FNAB) nodule depth on pain score



Fine-needle aspiration biopsy (FNAB) of the thyroid is generally a well-tolerated procedure associated with weak levels of pain. However, pain may be very intense in some patients. The cause for the pain in these patients has not been identified. The hypothesis of this study is that there is a likely relationship between pain level and nodule depth during FNAB.

Materials and methods

Included in the study were 98 patients with euthyroid nodular goiter who underwent FNAB. When ultrasound guided thyroid fine-needle aspiration biopsy was performed findings such as the distance of the nodule to the skin, the size of the nodule, visual analogue scale (VAS) score values were recorded.


The distance of nodule to skin and nodule size was measured, respectively, as 10.7 ± 2.8 mm and 21.7 ± 8.6 mm. Mean VAS score was 36 ± 16. FNAB-related pain was correlated with the nodule depth (r = 0.43, p < 0.001). In the logistic regression analysis, we also found that high VAS score class was effected by only nodule depth (B = −1.619; OR 1.287; CI 1.057–1.565, p < 0.05).


Our results show that pain increased significantly during FNAB in patients who had more deeply situated nodules. Local anesthetic methods may be recommended for these patients.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Gharib H, Papini E, Paschke R et al (2010) 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. J Endocrinol Invest 33(5):287–291. doi:10.3275/7048

    Article  CAS  PubMed  Google Scholar 

  2. Gharib H, Goellner JR (1993) Fine-needle aspiration biopsy of thyroid: an appraisal. Ann Intern Med 118(4):282–289. doi:10.7326/0003-4819-118-4-199302150-00007

    Article  CAS  PubMed  Google Scholar 

  3. Polyzos SA, Anastasilakis AD (2010) Systematic review of cases reporting blood extravasation-related complications after thyroid fine-needle biopsy. J Otolaryngol Head Neck Surg 39(5):532–541

    PubMed  Google Scholar 

  4. Lo WC, Cheng PW, Wang CT et al (2014) Pain levels associated with ultrasound-guided fine-needle aspiration biopsy for neck masses. Head Neck 36(2):252–256. doi:10.1002/hed.23303

    Article  PubMed  Google Scholar 

  5. Gursoy A, Ertugrul TD, Sahin M et al (2007) 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(4):317–321. doi:10.1089/thy.2006.0326

    Article  CAS  PubMed  Google Scholar 

  6. Leboulleux S, Borget I, Labro S et al (2013) Frequency and intensity of pain related to thyroid nodule fine needle aspiration cytology. Thyroid 23(9):1113–1118. doi:10.1089/thy.2012.0461

    Article  PubMed  Google Scholar 

  7. Gursoy A, Ertugrul DT, Sahin M et al (2007) The analgesic efficacy of lidocaine/prilocaine (EMLA) cream during fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf) 66(5):691–694. doi:10.1111/j.1365-2265.2007.02802.x

    Article  CAS  Google Scholar 

  8. Kim DW, Rho MH, Kim KN (2009) 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(5):441–446. doi:10.3348/kjr.2009.10.5.441

    Article  PubMed  PubMed Central  Google Scholar 

  9. Matthey-Gie ML, Walsh SM, O’Neill AC et al (2014) Ultrasound predictors of malignancy in indeterminate thyroid nodules. Ir J Med Sci 183(4):633–637. doi:10.1007/s11845-013-1065-0

    Article  PubMed  Google Scholar 

  10. Bomeli SR, LeBeau SO, Ferris RL (2010) Evaluation of a thyroid nodule. Otolaryngol Clin North Am 43(2):229–238. doi:10.1016/j.otc.2010.01.002

    Article  PubMed  PubMed Central  Google Scholar 

  11. Demirci H, Erdamar H, Karakoc A et al (2010) Thyroid fine needle aspiration biopsy: is topical local anaesthesia beneficial? Int J Clin Pract 64(1):25–28. doi:10.1111/j.1742-1241.2008.01814.x

    Article  CAS  PubMed  Google Scholar 

  12. Craig AD (2003) Pain mechanisms: labeled lines versus convergence in central processing. Annu Rev Neurosci 26:1–30. doi:10.1146/annurev.neuro.26.041002.131022

    Article  CAS  PubMed  Google Scholar 

  13. Meng Z, Lu G (2000) Projection linkage from spinal neurons to both lateral cervical nucleus and solitary tract nucleus in the cat. Biol Signals Recept 9(1):38–44

    Article  CAS  PubMed  Google Scholar 

  14. Millan MJ (1999) The induction of pain: an integrative review. Prog Neurobiol 57(1):1–164. doi:10.1016/S0301-0082(98)00048-3

    Article  CAS  PubMed  Google Scholar 

  15. Katz J, Melzack R (1999) Measurement of pain. Surg Clin North Am 79(2):231–252. doi:10.1016/S0039-6109(05)70381-9

    Article  CAS  PubMed  Google Scholar 

  16. Choiniere M, Amsel R (1996) A visual analogue thermometer for measuring pain intensity. J Pain Symptom Manage 11(5):299–311. doi:10.1016/0885-3924(95)00204-9

    Article  CAS  PubMed  Google Scholar 

  17. Cepeda MS, Carr DB (2003) Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg 97(5):1464–1468. doi:10.1213/01.ANE.0000080153.36643.83

    Article  PubMed  Google Scholar 

  18. Feine JS, Bushnell MC, Miron D et al (1991) Sex differences in the perception of noxious heat stimuli. Pain 44(3):255–262. doi:10.1016/0304-3959(91)90094-E

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to H. Toman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest. The authors have no financial relationship with the companies that manufactured the materials used in this study.

Ethical approval

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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Toman, H., Ozkul, F., Erbag, G. et al. Effects of fine-needle aspiration biopsy (FNAB) nodule depth on pain score. Ir J Med Sci 185, 673–676 (2016).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Thyroid nodule
  • Pain
  • Nodule depth
  • FNAB
  • VAS score