Ann Surg Treat Res.  2019 May;96(5):216-222. 10.4174/astr.2019.96.5.216.

Negative pressure is not necessary for using fine-needle aspiration biopsy to diagnose suspected thyroid nodules: a prospective randomized study

• Lee J
• Kim BK
• Sul HJ
• Kim JO
• Lee J
• Sun WY

• KMID: 2443584
• DOI: http://doi.org/10.4174/astr.2019.96.5.216

Abstract

PURPOSE
Fine-needle aspiration biopsy (FNAB) can be used to diagnose thyroid cancer and other tumors. Although FNAB without negative pressure (FNAB−P) reduces the risk of blood contamination, FNAB with negative pressure (FNAB+P) increases the sensitivity of the biopsy results. Therefore, we performed a randomized study of FNAB with or without negative pressure to identify the better diagnostic method.
METHODS
Between March 2016 and February 2017, 172 consecutive patients were enrolled to investigate >0.5 cm nodules with indeterminate or suspicious malignant features. Patients were randomly assigned to the FNAB+P group (a 50 mL syringe was used to provide negative pressure) or to the FNAB−P group (passive collection of blood in the needle's hub). The 2 methods' diagnostic adequacy and quality were evaluated using an objective scoring system. The study's protocol was registered with the World Health Organization Clinical Research Information Service (http://cris.nih.go.kr/cris, KCT0001857).
RESULTS
The patients were randomly assigned to the FNAB+P group (n = 86) or the FNAB−P group (n = 86). There were no significant intergroup differences in nodule position, size, age, consistency, calcification, BRAF mutation, or pathology. Evaluation of diagnostic adequacy parameters revealed no significant differences in background blood/clot (P = 0.728), amount of cellular material (P = 0.052), degree of cellular degeneration (P = 0.622), degree of cellular trauma (P = 0.979), or retention of appropriate architecture (P = 0.487). Furthermore, there was no significant intergroup difference in the diagnostic quality (P = 0.634).
CONCLUSION
This prospective randomized study failed to detect significant differences in the diagnostic adequacy and quality of FNAB with or without negative pressure. Therefore, the examiner may select whichever FNAB method they prefer.

Keyword

Thyroid nodule; Fine-needle biopsy; Cytological techniques

MeSH Terms

Biopsy
Biopsy, Fine-Needle*
Cytological Techniques
Humans
Information Services
Methods
Pathology
Prospective Studies*
Syringes
Thyroid Gland*
Thyroid Neoplasms
Thyroid Nodule*
World Health Organization

Figure

• 

  Fig. 1 Study flow chart. FNAB, fine-needle aspiration biopsy; FNAB+P, FNAB with negative pressure; FNAB−P, FNAB without negative pressure.

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  Fig. 2 A schematic figure of fine-needle aspiration biopsy with negative pressure. A 50-mL syringe is connected to the line and cells are removed by applying negative pressure to the syringe.

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