Systematic review of cases reporting blood extravasation-related complications after thyroid fine-needle biopsy.

OBJECTIVE

Thyroid fine-needle biopsy (FNB) is the procedure of choice in the preoperative management of thyroid nodules because of its accuracy and cost-effectiveness. Minor hematomas are the most common complications, but their morbidity is usually negligible. On the other hand, massive hematomas seem to be rare, but life-threatening, if the performer is unaware or careless and the patient is not adequately informed. In this review, we tried to summarize all reported blood extravasation-related post-FNB complications (hemorrhage, hematomas, and secondary hemangiomas) and provide useful hints to avoid them.

DESIGN

Systematic review of the literature.

SETTING

Second Medical Clinic of Aristotle University of Thessaloniki in Greece.

METHODS

Computerized advanced search for primary evidence was performed in the PubMed (Public/Publisher MEDLINE) electronic database. The search was not limited by publication time or English language.

RESULTS

The reported incidence of blood extravasation-related complications during or after FNB ranges between 1.9 and 6.4% in different studies. This variability is possibly due to definition or record biases. Intranodular hemorrhage within the cystic part of complex nodules following fluid aspiration seems to be even more frequent. Seven cases of post-FNB life-threatening massive hematomas resulting in airway obstruction were found as well as four described cases with secondary hemangioma attributed to FNB.

CONCLUSIONS

Despite the potential risk of post-FNB hemorrhage, hematomas, or secondary hemangiomas, the overall usefulness and safety of FNB are not questionable, considering the large number of FNBs performed worldwide everyday.