Tanaka Aki, Hirokawa Mitsuyoshi, Higuchi Miyoko, Kanematsu Risa, Suzuki Ayana, Kuma Seiji, Hayashi Toshitetsu, Kudo Takumi, Miyauchi Akira
Department of Clinical Laboratory, Kuma Hospital, Kobe, Japan.
Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan.
Endocr J. 2019 Feb 28;66(2):143-147. doi: 10.1507/endocrj.EJ18-0422. Epub 2018 Nov 21.
Concerning the needle size for thyroid fine needle aspiration cytology (FNAC), 25-27-gauge needles are generally used in Western countries. However, in Japan, the use of larger needles (21-22-gauge needles) is common. The aim of our study was to determine the optimal needle size for thyroid FNAC. We performed ultrasound-guided FNAC for 200 thyroid nodules in 200 patients using two different-sized needles (22 and 25 gauge). For each nodule, two passes with the different-sized needles were performed. The order of needle sizes was reversed for the second group of 100 nodules. The second aspiration was more painful than the first, regardless of the needle size. An association with more severe blood contamination was more frequently observed with the use of 22-gauge needles (32.0%) than with the use of 25-gauge needles (17.5%) and in the second aspiration (37.5%) than in the initial aspiration (12.0%). The initial aspiration samples were more cellular than the second aspiration samples. Regarding the unsatisfactory and malignancy detection rates, there was no statistical difference between the needles. In three of seven markedly calcified nodules, it was difficult to insert 25-gauge needles into the nodules. In terms of the diagnostic accuracy and pain, either needle size can be used. We recommend using 22-gauge needles for markedly calcified nodules because 25-gauge needles bend more easily in such cases. We demonstrated that the initial aspiration tended to obtain more cellular samples and to be less contaminated. Thus, the initial aspiration is more important and should be closely attended.
关于甲状腺细针穿刺抽吸活检（FNAC）的针具规格，西方国家一般使用25 - 27号针。然而，在日本，使用较大规格的针（21 - 22号针）更为常见。我们研究的目的是确定甲状腺FNAC的最佳针具规格。我们使用两种不同规格的针（22号和25号），对200例患者的200个甲状腺结节进行了超声引导下的FNAC。对于每个结节，使用不同规格的针各穿刺两次。在第二组100个结节中，针具规格的顺序颠倒。无论针具规格如何，第二次穿刺都比第一次更疼。与25号针（17.5%）相比，使用22号针（32.0%）以及第二次穿刺（37.5%）比初次穿刺（12.0%）更常观察到与更严重血液污染的相关性。初次穿刺样本比第二次穿刺样本细胞更多。关于不满意率和恶性肿瘤检出率，两种针具之间没有统计学差异。在7个明显钙化的结节中有3个，难以将25号针插入结节。就诊断准确性和疼痛而言，两种针具规格均可使用。对于明显钙化的结节，我们建议使用22号针，因为在这种情况下25号针更容易弯曲。我们证明初次穿刺往往能获取更多细胞样本且污染更少。因此，初次穿刺更重要，应密切关注。
