Frequency and Intensity of Pain Related to Thyroid Nodule Fine-Needle Aspiration Cytology

Background: Quality of life is an important issue in endocrine tumors because of the high prevalence of benign tumors and the indolent course of most malignant tumors. Objective: To evaluate the frequency and the intensity of pain and anxiety in patients undergoing thyroid nodule fine-needle aspiration cytology (FNAC) and to identify factors associated with pain. Methods: Single center prospective study in the setting of a one-stop outpatient diagnostic clinic for thyroid nodules. Pain was evaluated using a 100-mm visual analogue scale (VAS) immediately following (VAS(1)) and 30 minutes after (VAS(2)) FNAC and was considered significant if >= 30. Anxiety symptoms were assessed prior to FNAC using a self-report measure questionnaire: the state form of Spielberger State-Trait Anxiety Inventory (STAI, form Y-A). FNAC was performed with a 25-gauge needle and a moderate aspiration and two passes for each nodule. Results: Two hundred eighteen consecutive patients (163 females, 55 males; mean age 53 years, range 12-84 years) undergoing FNAC of one to three nodules were included. VAS(1) was >= 30 in 24% of the patients and VAS(2) was >= 30 in 13% of the patients. Independent significant factors correlated to a VAS(1) of >= 30 were age under 25 years and the number of nodules being biopsied. Independent significant factors correlated to a VAS(2) of >= 30 were VAS(1) >= 30 and female sex. No correlation was found between pain and nodule size or nodule depth, nor the duration of application of the eutectic mixture of local anesthetics (EMLA) patch prior to FNAC. The mean STAI score for anxiety was 37 +/- 12. The average STAI score was significantly higher in women (39) than in men (33; p=0.01). There was no significant correlation between STAI score and age under 25 years, previous FNAC, number of nodules biopsied, or acetaminophen administration, but the STAI score was significantly correlated to VAS(1) and VAS(2). Conclusions: FNAC-related pain is frequent and correlates with the number of nodules biopsied, age under 25 years, female sex, and anxiety.