Ultrasound-Guided Conventional Versus Trans-isthmic Fine Needle Aspiration: Comparison of Post-biopsy Hematoma Rates and Patients’ Pain

Objective Fine needle aspiration (FNA) is an invasive procedure; however, it is the simplest and safest method of identifying thyroid nodules that is well tolerated by patients. The most common complication is minor bleeding and pain. The objective of this study was to evaluate pain and complications among patients with thyroid nodules undergoing ultrasound (US)-guided FNA procedures. Materials and methods A total of 757 patients who underwent US-guided biopsy of the thyroid nodule in our institution between January 2017 and July 2022 were reviewed retrospectively. Demographic characteristics, US features, nodule depth and size, developing hematoma dimensions, and visual analog scale (VAS) scores during the procedure and at the 30th minute after the procedure were recorded in all cases. Results Overall, 272 (206 female and 66 male) patients who underwent US-guided conventional FNA (US-CFNA) procedure and 485 (361 female and 124 males) patients who underwent US-guided trans-isthmic FNA (US-TIFNA) were included. There was no significant difference between the two groups in terms of gender or age (p=0.691 and p=0.539, respectively). Although the mean nodule size of the US-TIFNA group was larger than that of the US-CFNA group, there was no statistically significant difference between the groups (p=0.137). There was a statistically significant difference between the two groups regarding the mean pain score during the procedures and 30 minutes after the procedure (p=0.032 and p=0.001, respectively). A total of 18 patients had procedural bleeding complications. While hematoma was detected in 11 (4.04%) patients who underwent the US-CFNA procedure, it was detected in seven (1.44%) patients who underwent the TIFNA procedure (p=0.024). Conclusion We compared the incidence of hematoma and the comfort of patients during and after the procedure between the US-TIFNA procedure and the US-CFNA procedure. The frequency of hematoma was higher in US-CFNA patients during and after the biopsy, and it was statistically significant. Moreover, the evaluation of patients’ pain levels has shown that the US-TIFNA procedure resulted in significant patient satisfaction.