Prospective randomized clinical trial of the effect of needle size on pain, sample adequacy and accuracy in head and neck fine-needle aspiration cytology.

Background: Fine-needle aspiration cytology (FNAC) is useful in the diagnosis of many conditions of the head and neck. No reported studies have investigated the optimal needle gauge in the head and neck region.

Methods: This was a prospective randomized trial of 100 patients who required FNAC performed with either a 21G or 23G needle. Discomfort was scored by patients using a visual analogue scale. Sample accuracy was assessed in patients who subsequently had excision biopsy.

Results: FNAC performed with a 23G needle was less painful (mean +/- SE, 1.6 +/- 1.01) than FNAC with a 21G needle (3.3 +/- 1.94; p < .001). There was no difference in sample adequacy between the 2 needle sizes (p = .59). The sensitivities and specificities of both needles were similar.

Conclusion: Head and neck FNAC should routinely be performed with a 23G needle, resulting in less patient discomfort, and giving sample adequacy comparable to a conventional 21G needle.