Discussion
bleeding
BLEEDING, THYROID NODULES
Puncture needles with a stylet is widely used by many puncturers during thyroid FNA (Besides, there are limited data comparing thyroid FNA with and without a stylet. A published trial comparing the two techniques compared only a subset of selected thyroid nodules (hypoechoic vascular type II nodules) (However, a previous published study comparing thyroid FNA with and without a stylet showed that a stylet can improve specimen adequacy (Furthermore, only 480 of 2750 patients were screened in the study comparing thyroid FNA with and without a stylet (There is no doubt that the higher cost of puncture needles with a stylet than those without a stylet, such as an ordinary syringe needle, will significantly increase the puncture cost for patients. Therefore, its higher cost of puncture needles with stylet is unjustified if it does not improve specimen quality. Considering a large number of FNA examinations performed worldwide each year, the cost issue is not irrelevant. Our findings provide a reasonable basis for using low-cost puncture needles without a stylet can be used during thyroid FNA, which would reduce the average per-patient puncture cost and save health insurance funds.In this study, the patient population was representative of the typical patient population seen by most thyroid surgeons working in tertiary referral centers, with most being women and a wide age range. Therefore, the results may broadly apply to most patients with thyroid nodules. FNA is an operation-dependent procedure. Herein, only one experienced operator performed the procedures, thus excluding the influence of inter-operator differences. Furthermore, a non-inferiority design was used to ensure an adequate sample size. A randomized design was used for the order of S+ first or S- first puncture of each nodule to exclude the effect of bleeding from the first puncture on the adequacy of the second specimen. Patients using anticoagulant therapy, such as aspirin and warfarin, were excluded since these treatments affect specimen adequacy (This study has some limitations. First, the operator was not blinded to the stylet status of each puncture since this is logically impossible. Second, five cytopathologists interpreted the slides, and interobserver variation may have occurred during the interpretation. However, all slides from one patient were evaluated by the same cytopathologist. Third, only 25-gauge needles were used, and thus these results may not apply to other needle sizes. Finally, the sensitivity, specificity, and accuracy of the two techniques were not explored.