Is Patient Anxiety A Risk Factor for FNAB Sample Adequacy?

Senoymak Mustafa Can; Erbatur Nuriye Hale; İsmail Engin; Arif Yonem

doi:10.1530/endoabs.90.P814

Aim: Currently, imaging tools are increasing the frequency of thyroid nodules to 50%, and thyroid cancer risk is 7-15%. The most cost-effective, accurate diagnosis method is fine-needle aspiration biopsy (FNAB). However, non-diagnostic (ND) results can delay diagnosis, cause different procedures, raise costs, and distress patients. In addition, FNAB sample adequacy is affected by advanced age, nodule size (<5-10mm), cystic dominating nodules, macrocalcification, and hypo-echogenicity. We aimed to see if situational anxiety was linked to non-diagnostic cytology.

Methods: The prospective cross-sectional study included patients who underwent thyroid fine-needle aspiration at the Endocrinology Clinic of Sultan Abdulhamid Training and Research Hospital between 11/2022 and 02/2023. The State-Trait Anxiety Inventory (STAI) questionnaire and visual analog scale (VAS) for pain assessed situational anxiety and pain in patients just before the procedure. We tested whether the STAI-S score is related to non-diagnostic results.

Results: Of the 119 patients included in the study, 98 were female, and 21 were male. 25 (21%) nodules were non-diagnostic. We divided patients into two groups according to the cytology results: non-diagnostic and others. According to the groups, STAI and VAS scores and other demographic characteristics are given in Table 1. A statistically significant relation was found between the patient’s STAI-S score and VAS score and the cytology result of non-diagnostic thyroid nodules (P= 0.001 and P=0.008). When we examined the factors associated with the non-diagnostic outcome in multivariate logistic regression analysis, the STAI-S score was found to be again associated with the non-diagnostic outcome. (OR=1.069, P=0.02)

Table 1. Characteristics of the patients, STAI, and VAS scores
Parameters	All patients	Non-diagnostic group	Others	P value
Number of patients	119	25	94
Age(years)	54.86±12.2	58.64±12.05	53.86±12.15	0,087
Gender(n)				0,38
F	98	19	79
M15	21	6	15
STAI-S	47.31±12.37	54,80±13.42	45.31±11.34	0,001
VAS	2.57±1.51	3(1-6)	2(1-6)	0,008
Nodule size(mm)	21.70±0.72	21.60±8.45	21.73±7.68	0.94
Architecture (cyst/solid)	26/93	8/17	18/76	0.16
Boundary (regular/irregular)	18/101	3/22	15/79	0.44
Echogenicity (hypo/iso)	61/58	15/10	46/48	0.37
Macrocalcification (absent/present)	19/100	5/25	14/80	0.54
F: Female, M: Male, STAI-S: Situational State-Trait Anxiety Inventory, VAS: visual analog scale. Independent-Samples T (2 variables) test was used for parametric variables, and data were given as mean±SD. Mann-Whitney test was used for non-parametric variables, and data were shared median (minimum-maximum).

Conclusions: Hence, anxiety level and pain perception during FNAB may be risk factors for non-diagnostic cytology. Reducing anxiety and pain may decrease the incidence of non-diagnostic outcomes.

Endocrine Abstracts

P814