Chiba Needle Application In Thyroid Nodules & Cervical Lymphadenopathy

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Ultrasound-guided FNA of thyroid nodules and cervical lymph nodes is a Grade A recommendation​ in international guidelines; 22G–23G Chiba needles are the instrument of choice.

Thyroid Nodule FNA

Patient supine, neck extended; US identifies solid portions (avoid cystic/calcified zones).

Disinfect; minimal dermal/subcutaneous lidocaine (avoid deep infiltration obscuring image).

22G/23G Chiba in-plane → tip within solid nodule → 2–5 mL suction → gentle fanning 1–2 s → withdraw with suction → expel onto slide → smear & 95% EtOH fix.

2–3 passes​ from different solid areas recommended, especially for Bethesda I risk nodules.

Report interpreted per Bethesda System.

Cervical Lymph Node FNA

Target: cortex thickening, loss of hilum, microcalcifications, cystic change

Avoid: fatty hilum, central necrosis

If TB suspected → AFB stain/culture; if lymphoma suspected → consider core biopsy after FNA

Color Doppler to ensure safe distance from carotid

Advantages of Chiba Needle in Thyroid/LN FNA

22G–23G → minimal hematoma, no impact on future surgery

Non-cutting → extremely low tract seeding risk

Real-time US guidance avoids trachea, esophagus, carotid, RLN

Troubleshooting Unsatisfactory Smears

Excess suction → hemolysis → use gentle suction or capillary method

Sampling only cystic content → re-target solid/mural nodule

Very small nodule (<5 mm) → 23G short needle, freehand technique

ROSE (on-site cytotech) → immediate adequacy check → fewer inadequate passes

Complications

Mild pain, small ecchymosis (resolve 1–2 days)

Rare infection

Contraindications: uncorrected coagulopathy, local cellulitis, patient non-cooperation

Chiba needle FNA bridges imaging risk stratification and therapeutic decision-making in thyroid & nodal disease - proper technique and specimen handling are essential.