Shumrick Christopher M, Simmonds Jonathan C, Ogden Lorna L, Snowden Cindi A, Dhingra Jagdish K
Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA.
Thyroid Cytopathology Partners, Austin, Texas, USA.
OTO Open. 2021 May 10;5(2):2473974X211013732. doi: 10.1177/2473974X211013732. eCollection 2021 Apr-Jun.
To compare diagnostic capability and patient pain between 25-gauge (25G) and 27G needles for ultrasound-guided fine-needle biopsy of thyroid nodules.
Prospective blinded randomized trial.
Thyroid clinic in otolaryngology practice in a community.
A prospective randomized blinded trial was conducted on 148 thyroid nodules in 107 patients undergoing ultrasound-guided fine-needle biopsy. Needle gauge was randomized to individual nodule. Patients were blinded to the needle size used. All specimens were assessed via the Bethesda System for Reporting Thyroid Cytopathology and assigned a morphologic quantitative score based on number of thyroid cells and lymphocytes, amount of colloid, and degree of blood/fibrin artifact in each sample. Patient pain experience was scored. A chi-square test was used to compare nondiagnostic rates, and differences in cytologic morphology and pain scores were compared with 2-sample Student tests.
Of the 148 nodules, 77 were biopsied with 25G needles and 71 with 27G needles. Twenty-five percent (19/77) of the samples obtained with 25G needles yielded a nondiagnostic cytology result (Bethesda category 1) as compared with 11% (8/70) in the 27G group ( = .0282; 95% CI, 1.47%-25.97%). On average, samples from 25G needles had a higher blood/fibrin quantitative score ( = .043; 95% CI, -0.64 to -0.010). There were no differences in pain between groups.
Use of a 27G needle for fine-needle biopsies is not only safe and feasible but desirable and highly recommended, as it yields better diagnostic information.
比较25号（25G）和27G针用于超声引导下甲状腺结节细针穿刺活检的诊断能力及患者疼痛情况。
前瞻性双盲随机试验。
社区耳鼻喉科诊所的甲状腺门诊。
对107例接受超声引导下细针穿刺活检的患者的148个甲状腺结节进行前瞻性随机双盲试验。针对每个结节随机分配针的规格。患者对所使用的针的大小不知情。所有标本均通过甲状腺细胞病理学报告的贝塞斯达系统进行评估，并根据每个样本中的甲状腺细胞和淋巴细胞数量、胶体含量以及血液/纤维蛋白伪像程度分配形态学定量评分。对患者的疼痛体验进行评分。采用卡方检验比较非诊断率，并使用双样本t检验比较细胞形态学和疼痛评分的差异。
148个结节中，77个用25G针进行活检，71个用27G针进行活检。25G针获取的样本中有25%（19/77）产生了非诊断性细胞学结果（贝塞斯达分类1类），而27G组为11%（8/70）（P = 0.0282；95%CI，1.47%-25.97%）。平均而言，25G针获取的样本血液/纤维蛋白定量评分更高（P = 0.043；95%CI，-0.64至-0.010）。两组之间疼痛无差异。
使用27G针进行细针活检不仅安全可行，而且是可取的并强烈推荐，因为它能提供更好的诊断信息。
