Abstract
Introduction: Approximately 15% of fine-needle aspiration (FNA) of thyroid nodules are considered nondiagnostic. Several factors are potentially involved, including clinical and nodule features but also the gauge (G) of the needle used. However, few studies have compared the cytological adequacy obtained with different gauge needles and the data are controversial. We aimed to evaluate cytological adequacy results using 23- or 25-G needles. Methods: This study is an observational and prospective study of thyroid nodules submitted to ultrasound-guided FNA. The procedure was performed randomly using 23- or 25-G needles. The samples were reported by different cytopathologists who were blinded to the information of the gauge of the needle used. Statistical analysis was performed to compare cytological adequacy of FNA between the two groups. Results: A total of 177 thyroid nodules were included – 98 (55.4%) using 23-G and 79 (44.6%) using 25-G needles. The 23-G group presented a higher rate of cytological adequacy (69.4% [68/98] vs. 46.8% [37/79], p = 0.002). No differences were found between the two groups regarding patient or nodule characteristics. On logistic regression, 23-G needles correlated with better cytological adequacy (unadjusted OR 2.57 [95% CI: 1.39–4.77]), even after adjusting for nodule dimension, location, and type of cytology (slides +/− additional liquid-based cytology) (adjusted OR 2.44 [95% CI: 1.23–4.84]). Conclusion: The gauge of the needle used was found to be an independent predictor of cytological adequacy, with 23-G needles providing more adequate samples. Further investigation is needed to confirm our results in order to stablish the optimal diagnosis technique.
Journal Section:
Fine Needle Aspiration
References
1.
Miranda-Filho
A
, Lortet-Tieulent
J
, Bray
F
, Cao
B
, Franceschi
S
, Vaccarella
S
, et al. Thyroid cancer incidence trends by histology in 25 countries: a population-based study
. Lancet Diabetes Endocrinol
. 2021
;9
(4
):225
–34
. doi: .2.
Haugen
BR
, Alexander
EK
, Bible
KC
, Doherty
GM
, Mandel
SJ
, Nikiforov
YE
, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer
. Thyroid
. 2016
;26
(1
):1
–133
. doi: .3.
Hegedüs
L
. Clinical practice. The thyroid nodule
. N Engl J Med
. 2004
;351
(17
):1764
–71
. doi: .4.
American Thyroid Association ATA Guidelines Taskforce on Thyroid Nodules and Different, iated Thyroid Cancer
; Cooper
DS
, Doherty
GM
, Haugen
BR
, Kloos
RT
, Lee
SL
, et al. Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: the American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer
. Thyroid
. 2009
;19
(11
):1167
–214
. doi: .5.
Papini
E
, Guglielmi
R
, Bianchini
A
, Crescenzi
A
, Taccogna
S
, Nardi
F
, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features
. J Clin Endocrinol Metab
. 2002
;87
(5
):1941
–6
. doi: .6.
Sidawy
MK
, Vecchio
DMD
, Knoll
SM
. Fine-needle aspiration of thyroid nodules: correlation between cytology and histology and evaluation of discrepant cases
. Cancer
. 1997
;81
(4
):253
–9
. doi: .7.
Ali
SZ
, Baloch
ZW
, Cochand-Priollet
B
, Schmitt
FC
, Vielh
P
, VanderLaan
PA
. The 2023 Bethesda System for Reporting Thyroid Cytopathology
. Thyroid
. 2023
;33
(9
):1039
–44
. doi: .8.
Gharib
H
, Goellner
JR
. Fine-needle aspiration biopsy of the thyroid: an appraisal
. Ann Intern Med
. 1993
;118
(4
):282
–9
. doi: .9.
Grani
G
, Calvanese
A
, Carbotta
G
, D'Alessandri
M
, Nesca
A
, Bianchini
M
, et al. Intrinsic factors affecting adequacy of thyroid nodule fine-needle aspiration cytology
. Clin Endocrinol
. 2013
;78
(1
):141
–4
. doi: .10.
Zhang
L
, Liu
Y
, Tan
X
, Liu
X
, Zhang
H
, Qian
L
. Comparison of different-gauge needles for fine‐needle aspiration biopsy of thyroid nodules
. J Ultrasound Med
. 2018
;37
(7
):1713
–6
. doi: .11.
Cerit
M
, Yücel
C
, Göçün
PU
, Poyraz
A
, Cerit
ET
, Taneri
F
. Ultrasound-guided thyroid nodule fine-needle biopsies — comparison of sample adequacy with different sampling techniques, different needle sizes, and with/without onsite cytological analysis
. Endokrynol Pol
. 2015
;66
(4
):295
–300
. doi: .12.
Lee
YJ
, Kim
DW
, Shin
GW
, Heo
YJ
, Baek
JW
, Choo
HJ
, et al. Comparison of cytological adequacy and pain scale score in ultrasound-guided fine-needle aspiration of solid thyroid nodules for liquid-based cytology with with 23- and 25-gauge needles: a single-center prospective study
. Sci Rep
. 2019
;9
(1
):7027
. doi: .13.
Tanaka
A
, Hirokawa
M
, Higuchi
M
, Kanematsu
R
, Suzuki
A
, Kuma
S
, et al. Optimal needle size for thyroid fine needle aspiration cytology
. Endocr J
. 2019
;66
(2
):143
–7
. doi: .14.
Tangpricha
V
, Chen
BJ
, Swan
NC
, Sweeney
AT
, De Las Morenas
A
, Safer
JD
. Twenty-one–gauge needles provide more cellular samples than twenty-five–gauge needles in fine-needle aspiration biopsy of the thyroid but may not provide increased diagnostic accuracy
. Thyroid
. 2001
;11
(10
):973
–6
. doi: .15.
Layfield
LJ
, Cibas
ES
, Gharib
H
, Mandel
SJ
. Thyroid aspiration cytology: current status
. CA Cancer J Clin
. 2009
;59
(2
):99
–110
. doi: .16.
Zajdela
A
, Zillhardt
P
, Voillemot
N
. Cytological diagnosis by fine needle sampling without aspiration
. Cancer
. 1987
;59
(6
):1201
–5
. doi: .17.
Baloch
ZW
, Cibas
ES
, Clark
DP
, Layfield
LJ
, Ljung
BM
, Pitman
MB
, et al. The National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference: a summation
. CytoJournal
. 2008
;5
(1
):6
. doi: .18.
Titton
RL
, Gervais
DA
, Boland
GW
, Maher
MM
, Mueller
PR
. Sonography and sonographically guided fine-needle aspiration biopsy of the thyroid gland: indications and techniques, pearls and pitfalls
. AJR Am J Roentgenol
. 2003
;181
(1
):267
–71
. doi: .19.
Hirokawa
M
, Suzuki
A
, Miyauchi
A
. Thyroid fine-needle aspiration and smearing techniques
. VideoEndocrinology
. 2018
;5
(2
):ve.2018.0119
. doi: .20.
Russ
G
, Bonnema
SJ
, Erdogan
MF
, Durante
C
, Ngu
R
, Leenhardt
L
. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: the EU-TIRADS
. Eur Thyroid J
. 2017
;6
(5
):225
–37
. doi: .21.
Sukumaran
R
, Kattoor
J
, Pillai
KR
, Ramadas
PT
, Nayak
N
, Somanathan
T
, et al. Fine needle aspiration cytology of thyroid lesions and its correlation with histopathology in a series of 248 patients
. Indian J Surg Oncol
. 2014
;5
(3
):237
–41
. doi: .22.
Dobrinja
C
, Trevisan
G
, Liguori
G
, Romano
A
, Zanconati
F
. Sensitivity evaluation of fine-needle aspiration cytology in thyroid lesions
. Diagn Cytopathol
. 2009
;37
(3
):230
–5
. doi: .23.
Bongiovanni
M
, Spitale
A
, Faquin
WC
, Mazzucchelli
L
, Baloch
ZW
. The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis
. Acta Cytol
. 2012
;56
(4
):333
–9
. doi: .24.
Wang
CY
, Zhou
Y
, Ren
YY
, Luan
YS
, Jiang
ZC
, Wang
ZX
. Analysis of the influencing factors on fine-needle aspiration biopsy results of the thyroid
. Front Surg
. 2022
;9
:907086
. doi: .25.
Dong
Y
, Gao
L
, Sui
Y
, Mao
M
, Zhan
W
, Zhou
J
. Comparison of ultrasound-guided fine-needle cytology quality in thyroid nodules with 22-23-and 25-gauge needles. Amantini C
. Anal Cell Pathol
. 2021
;2021
:1
–7
. doi: .26.
Saraph
S
, Cohen
H
, Ronen
O
. Effect of needle gauge on thyroid FNA diagnostic rate
. Endocrine
. 2021
;74
(3
):625
–31
. doi: .27.
Rechter
M
, Saraph
S
, Cohen
H
, Ronen
O
. Nondiagnostic test result rates following thyroid extra-fine-needle aspiration
. Am J Clin Pathol
. 2023
;159
(1
):98
–102
. doi: .28.
Shumrick
CM
, Simmonds
JC
, Ogden
LL
, Snowden
CA
, Dhingra
JK
. A blinded randomized trial comparing 2 needle gauges for fine-needle biopsy of thyroid nodules
. OTO Open
. 2021
;5
(2
):2473974X211013732
. doi: .29.
Moss
WJ
, Finegersh
A
, Pang
J
, Califano
JA
, Coffey
CS
, Orosco
RK
, et al. Needle biopsy of routine thyroid nodules should be performed using a capillary action technique with 24- to 27-gauge needles: a systematic review and meta-analysis
. Thyroid
. 2018
;28
(7
):857
–63
. doi: .© 2024 S. Karger AG, Basel
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