The Effect of Needle Sizes for Sample Adequacy in Thyroid Nodule Fine-Needle Biopsies

Abstract

Aim: The aim of this study was to compare the diagnostic adequacy of thyroid samples obtained with 22-Gauge and 27-Gauge needles. Materials and Methods: From January 2019 to December 2019, 860 patients with thyroid nodules who underwent ultrasound-guided fine-needle biopsies were included in this retrospective study. The results of the samples taken were classified cytologically according to the Bethesda 2017classification. Sample adequacy rates were calculated for each group and compared using chi-square tests. Results: Our cytological results were reported as 157 (18,3%) inadequate materials (Bethesda1). There were no statistically significant differences among the adequacy rates achieved with 22- and 27-gauge needles (80.4% and 83.2%, respectively; P>0.05). There was no significant or permanent complication. Conclusion: There was no difference between 22 and 27-Gauge needle sizes in diagnostic adequate sample. Prospective randomized controlled studies are needed to examine the relationships between nodule, needle, and patient dependent variables.

Keywords

• fine-needle aspiration biopsy
• thyroid nodule
• adequacy
• needle size

Tiroid Nodül İnce İğne Biyopsinde Yeterli Tanısal Numune Almaya İğne Boyutunun Etkisi

Abstract

Amaç: Bu çalışmanın amacı 22 ve 27-Gauge boyutlu iğneler ile yapılan tiroid biyopsilerinde alınan sitolojik örneklerin patolojik olarak tanı verme yeterliliğini karşılaştırmaktır. Gereç ve Yöntem: Bu retrospektif çalışmaya Ocak 2019-Aralık 2019 tarihleri arasında 860 hastaya ultrason kılavuzluğunda yapılan tiroid ince iğne biyopsileri dahil edilmiştir. Alınan örneklerin sonuçları sitolojik olarak Bethesda 2017 sınıflamasına göre sınıflandırılmıştır. Örneklerin tanı yeterlilikleri her grup için ki-kare testi ile analiz edilmiştir. Bulgular: Toplam tanısal olmayan patoloji sonucu oranı %18,3 olarak bulundu (Bethesda 1). Araştırmamızda 22 ve 27-Gauge boyutlu iğneler ile elde edilen örneklerin tanısal yetersizlik oranları arasında istatistiksel olarak anlamlı bir farklılık yoktu (sırasıyla; %19,6 ve %16,8, P>0,05). Kalıcı veya ciddi bir komplikasyon görülmedi. Sonuç: İnce iğne biyopsisinin yeterli numune vermesi açısından 22 ve 27 Gauge iğne boyutları arasında fark görülmemektedir. İğneye, nodülün özelliğine ve hastaya bağlı değişkenler arasındaki ilişkileri incelemek için prospektif randomize kontrollü çalışmalara ihtiyaç vardır.

Keywords

• İnce iğne aspirasyon biyopsisi
• tiroid nodülü
• yeterlilik
• iğne boyutu

References

1. Referans1. Can AS, Peker K. Comparison of palpation-versus ultrasound-guided fine-needle aspiration biopsies in the evaluation of thyroid nodules. BMC Res Notes 2008;1:12.
2. Referans2. Cesur M, Corapcioglu D, Bulut S, et al. Comparison of palpation guided fine-needle aspiration biopsy to ultrasound-guided fine-needle aspiration biopsy in the evaluation of thyroid nodules. Thyroid 2006; 16:555–561.
3. Referans3. Martin HE, Ellis EB. Biopsy by needle puncture and aspiration. Ann Surg 1930; 92:169-181.
4. Referans4. Cerit M, Yücel C, Göçün PU, et al. 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; 66:295-300.
5. Referans5. Cappelli C. Pirola I, Agosti B, et al. Complications after fine needle aspiration cytology: a retrospective study of 7449 consecutive thyroid nodules. Br J Oral Maxillofacial Surg 2017; 55:266-269.
6. Referans6. Tanaka A, Hirokawa M, Higuchi M, et al. Optimal needle size for thyroid fine needle aspiration cytology, Endocrine Journal, 2019; 66(2):143-147.
7. Referans7. Fischer AH, Clayton AC, Bentz JS, et al. Performance differences between conventional smears and liquid-based preparations of thyroid fine needle aspiration samples: analysis of 47076 responses in the college of American pathologists interlaboratory comparison program in non-gynecologic cytology. Arch Pathol Lab Med 2013; 137:26–31.
8. Referans8. Degirmenci B, Haktanir A, Albayrak R, et al. Sonographically guided fine-needle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytological material. Clin Radiol 2007; 62: 798–803.

9. Referans9. 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 UltrasoundMed 2018; 37:1713–1716.
10. Referans10. Hanbidge AE, Arenson AM, Shaw PA, et al. Needle size and sample adequacy in ultrasound-guided biopsy of thyroid nodules. Can Assoc Radiol J 1995; 46: 199–201.
11. Referans11. 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; 11:973–976.
12. Referans12. Jung SJ, Kim DW, Baek HJ. Comparison study of the adequacy and pain scale of ultrasound-guided fine needle aspiration of solid thyroid nodules with a 21- or 23- gauge needle for liquid-based cytology: a single-center study. Endocr Pathol 2018; 29: 30–34.
13. Referans13. Baloch ZW, Cooper DS, Gharib H, Alexander EK. Overview of diagnostic terminology and reporting. In: Ali SZ, Cibas ES, editors. The Bethesda System for Reporting Thyroid Cytopathology (2nd). New York: Springer Nature; 2018.p.1–6.
14. Referans14. Gumus M, Cay N, Algin O, et al. Comparison of 21 and 27 gauge needles for determining sample adequacy in the aspiration biopsy of thyroid nodules. Diagn Interv Radiol 2012; 18:102–105.
15. Referans15. Leboulleux S, Borget I, Labro S, et al. Frequency and intensity of pain related to thyroid nodule fine-needle aspiration cytology. Thyroid 2013; 23:1113-1118.
16. Referans16. Carpi A, Rossi G, Nicolini A, et al. Does large needle aspiration biopsy add pain to the thyroid nodule evaluation? PLoS One 2013; 8(3): e58016.
17. Referans17. Lee YJ, Kim DW, Jung SJ. 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; 44: 696-701.
18. Referans18. Kwon J H, Kim D B, Han Y H, Cha Y K, Kim J S. Contributory Factors to Hemorrhage After Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules with an Emphasis on Patients Taking Antithrombotic or Anticoagulant Medications, Iran J Radiol. 2018; 15(2):e57231.
19. Referans19. Redman R, Zalaznick H, Mazzaferri EL et al. The Impact of Assessing Specimen Adequacy and Number of Needle Passes for Fine-Needle Aspiration Biopsy of Thyroid Nodules. Thyroid 2006; 16: 55-60.
20. Referans20. Stacul F, Bertolotto M, Zappetti R, et al. The radiologist and the cytologist in diagnosing thyroid nodules: results of cooperation. Radiol Med 2007; 112: 597-602.
21. Referans21. Olson MT, Tatsas AD, Ali SZ. Cytotechnologist-Attended On-Site Adequacy Evaluation of Thyroid Fine-Needle Aspiration: Comparison With Cytopathologists and Correlation With the Final Interpretation, American Journal of Clinical Pathology 2012; 138(1):90-95.