Division of Endocrinology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Queen's University School of Medicine, Kingston, Ontario, Canada.
Endocr Pract. 2022 Jun;28(6):628-636. doi: 10.1016/j.eprac.2022.03.007. Epub 2022 Mar 16.
Thyroid nodules are common, being detected in 19% to 67% of the population. A fine needle aspiration biopsy (FNAB) is recommended for suspicious thyroid nodules to rule out malignancy; however, the procedure can be painful for subsets of patients. It remains unclear what factors are more likely to be associated with pain during FNAB. This literature review aimed to investigate patient-, procedure-, and analgesic-related factors that affect pain levels during thyroid nodule FNAB.
Predefined inclusion and exclusion criteria were set to search the Embase, MEDLINE, CINAHL, and Cochrane databases. The articles evaluating the factors affecting pain during FNAB were assessed for inclusion. The primary outcome of interest was scores evaluating pain level during FNAB.
Twenty-two studies were included. The studies were a mix of cohort studies, randomized controlled trials, and clinical controlled trials. Under patient-related factor, nodule calcification was associated with increasing pain. The procedure-related factors potentially increasing pain included the number of needle passes and utilization of the aspiration technique (as opposed to capillary action), perpendicular needle placement (as opposed to parallel), and not using safety devices. Larger needle size, type of biopsy, operator expertise, and patient education did not appear to be correlated with pain. Subcutaneous lidocaine appeared to provide better pain relief than a topical analgesic.
With increasing use of FNAB as the diagnostic test of choice for assessing thyroid nodules, understanding patient-, procedure-, and analgesic-related factors associated with optimal patient satisfaction is imperative.
甲状腺结节很常见，在 19%至 67%的人群中被发现。对于可疑的甲状腺结节，建议进行细针穿刺活检（FNAB）以排除恶性肿瘤；然而，对于某些患者来说，该操作可能会引起疼痛。目前尚不清楚哪些因素更可能与 FNAB 期间的疼痛相关。本文献综述旨在研究与患者、操作和镇痛相关的因素，这些因素可能会影响甲状腺结节 FNAB 期间的疼痛程度。
设定了明确的纳入和排除标准，以搜索 Embase、MEDLINE、CINAHL 和 Cochrane 数据库。评估了影响 FNAB 期间疼痛程度的因素的文章。主要研究结果是评估 FNAB 期间疼痛水平的评分。
共纳入 22 项研究。这些研究包括队列研究、随机对照试验和临床对照试验。在患者相关因素中，结节钙化与疼痛增加有关。潜在增加疼痛的操作相关因素包括针的穿刺次数和抽吸技术的使用（相对于毛细血管作用）、垂直针的放置（相对于平行）以及不使用安全装置。较大的针的尺寸、活检类型、操作人员的专业知识和患者教育似乎与疼痛无关。皮下利多卡因似乎比局部镇痛药能提供更好的止痛效果。
随着 FNAB 作为评估甲状腺结节的首选诊断测试的广泛应用，了解与患者满意度相关的患者、操作和镇痛相关因素至关重要。
