Diagnosis of Thyroid Follicular Neoplasm: Fine-Needle Aspiration Versus Core-Needle Biopsy

Yoon, Ra Gyoung; Baek, Jung Hwan; Lee, Jeong Hyun; Choi, Young Jun; Hong, Myunghee; Song, Dong Eun; Kim, Tae Yong; Yoon, Jong Ho; Kim, Won

doi:10.1089/thy.2014.0140

Cited by 54 publications

(69 citation statements)

References 23 publications

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“…These differences between the NA and FOA subcategories seem closely related to the difference of histopathology because the FOA subcategory included mostly follicular lesions showing predominant microfollicle formation and rarely showing NA for papillary thyroid carcinoma. Our results also suggest that CNB is superior to RFNA in the diagnosis of follicular neoplasm in both the NA and FOA subcategories, which is supported by recent reports [25,26] that CNB is more sensitive and predictive of follicular neoplasm, and which could be explained by an advantage of CNB in providing better information of nodule architecture.…”

Section: Discussionsupporting

confidence: 89%

Role of Core Needle Biopsy in the Management of Atypia/Follicular Lesion of Undetermined Significance Thyroid Nodules: Comparison with Repeat Fine-Needle Aspiration in Subcategory Nodules

Min

Lee

et al. 2015

Eur Thyroid J

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Background: The role of repeat fine-needle aspiration (RFNA) or core needle biopsy (CNB) has not been established in nodules categorized as atypia/follicular lesion of undetermined significance (AUS/FLUS). Objective: The purpose of this study was to retrospectively determine whether CNB is more useful for management decisions than RFNA at each subcategory of AUS/FLUS nodules. Methods: This study included 158 AUS/FLUS nodules (≥1 cm) from 153 consecutive patients who underwent both RFNA and CNB. The AUS/FLUS nodules were subcategorized into nuclear atypia (NA) and follicular lesions with other atypia (FOA). The diagnostic results and rate of determined management by RFNA and CNB were compared at each subcategory. The diagnostic values of RFNA and CNB for malignancy were evaluated in nodules with final diagnoses. Results: CNB showed a lower rate of AUS/FLUS diagnosis, higher rates of benign and follicular neoplasm or suspicious for a follicular neoplasm (FN/SFN) diagnoses (p ≤ 0.038), and marginally higher rates of malignant diagnosis than RFNA in the NA subcategory. CNB showed a higher rate of FN/SFN (p = 0.007) than RFNA in the FOA subcategory. CNB also demonstrated a higher rate of surgery decision than RFNA in both the NA subcategory (20.2 vs. 9.6%, p < 0.001) and FOA subcategory (20.8 vs. 5.6%, p = 0.007), and a higher rate of observation decision only in the NA subcategory (48.1 vs. 35.6%, p = 0.035). CNB demonstrated a higher diagnostic performance for malignancy overall in the nodules compared with RFNA. Conclusion: CNB may be more useful for management decisions than RFNA in both the NA and FOA subcategories, and has the potential to be a first-line alternative diagnostic tool in initially diagnosed AUS/FLUS nodules.

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Section: Discussionsupporting

confidence: 89%

Role of Core Needle Biopsy in the Management of Atypia/Follicular Lesion of Undetermined Significance Thyroid Nodules: Comparison with Repeat Fine-Needle Aspiration in Subcategory Nodules

Min

Lee

et al. 2015

Eur Thyroid J

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“…After validation, we performed FGFR2b immunohistochemistry in 1584 gastric cancers from four tissue microarray sets from previous studies (Figure 1). [23][24][25] Of the 1584 specimens, FGFR2b immunohistochemistry was successfully performed in 1574 cases. The samples were obtained from patients who underwent surgical resection for primary gastric cancer at the Samsung Medical Center, Seoul, Korea, between 1996 and 2006.…”

Section: Patients and Study Designmentioning

confidence: 99%

FGFR2 in gastric cancer: protein overexpression predicts gene amplification and high H-index predicts poor survival

et al. 2016

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FGFR2 gene amplification, and resulting FGFR2 protein overexpression, is rare in gastric cancer patients, and development of an accurate and widely available method for mass screening to identify patients who may respond to treatment with fibroblast growth factor receptor (FGFR) inhibitors is important. We first screened 312 gastric cancer patients with known copy number variations by FGFR2b immunohistochemistry using FPR2-D, an isoformspecific antibody. Next, we performed immunohistochemistry on tissue microarrays from 1574 gastric cancer patients. Selected cases were analyzed for FGFR2 amplification by FISH. In addition, FGFR2b overexpression was studied in 88 matched primary and metastatic gastric cancers. In the first cohort, FGFR2b immunohistochemistry results correlated very well with those of copy number variation (r = 0.79) and FISH (r = 1.0). In total, FGFR2b overexpression was identified in 73 of 1974 gastric cancers (4%). The concordance between immunohistochemistry and FISH was extremely high; all 2+ and 3+ cases identified by immunohistochemistry were FGFR2 amplified. In the matched primary and metastatic gastric cancer pairs, the positivity and percentage of positive tumor cells were significantly higher in metastatic gastric cancers than in primary gastric cancers (8% vs 3% and 75% vs 47%, respectively; Po0.001). FGFR2b overexpression was significantly more frequent in gastric cancers with diffuse subtype (P = 0.01) and higher N stage (P = 0.006). FGFR2b overexpression with H-score ≥ 150 were independent prognostic factors for overall survival with hazard ratio of 1.836 (95% confidence interval, 1.034-3.261; P = 0.038). FGFR2b positivity in immunohistochemistry was strongly correlated with FGFR2 amplification. Given the low frequency of FGFR2 amplification in gastric cancers, FGFRb2 immunohistochemistry is an accurate screening tool to detect FGFR2 amplification, and both primary and metastatic gastric cancer tissues should be tested to select gastric cancer patients for treatment with FGFR2 inhibitors. Gastric cancer is the second most common cause of cancer-related deaths worldwide, and the prognosis of advanced gastric cancer is still poor. 1 Several large-scaled clinical trials have failed to demonstrate survival benefits of targeted therapeutic agents in patients with metastatic gastric cancer. Nevertheless, the REGARD trial demonstrated significantly longer progression-free survival of gastric cancer patients treated with ramucirumab, a monoclonal antibody against vascular endothelial growth factor receptor 2, compared with that of patients in the placebo group. 2 This was the first trial to demonstrate a meaningful benefit for a monotherapy in metastatic gastric cancer. The RAINBOW trial, which compared the efficacy of paclitaxel with or without ramucirumab in second-line chemotherapy, showed prolonged

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“…Several factors are related to NA not applicable Endocrine the non-diagnostic FNA results, such as calcification [53,56,57]. Yoon et al [58] used a new sampling technique [18] in order to validate that CNB is more useful than FNA for diagnosing follicular neoplasms. CNB is reportedly helpful for diagnosing rare thyroid malignancies such as lymphoma and anaplastic and medullary carcinomas [5,17,[59][60][61][62].…”

Section: Subgroup Analysesmentioning

confidence: 99%

The role of core-needle biopsy in the diagnosis of thyroid malignancy in 4580 patients with 4746 thyroid nodules: a systematic review and meta-analysis

et al. 2016

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To evaluate the effectiveness and complications of core-needle biopsy (CNB) compared to fine-needle aspiration (FNA) for diagnosing thyroid malignancy. The Ovid-MEDLINE and EMBASE databases were searched for studies using CNB for diagnosing thyroid malignancy. A meta-analysis was performed to evaluate the diagnostic accuracy, the incidence of non-diagnostic, inconclusive results, and the complications of CNB and FNA. To overcome the heterogeneity, additional analyses based on three, homogeneous inclusion criteria were performed and subgroup analyses were performed. Twenty eligible studies of 4580 patients (4746 nodules) were included. Both CNB and FNA demonstrated a high sensitivity (91 %, 74 %, respectively; p = .053) and specificity (99 %, 100 %, respectively; p = .914). The area under the curve was larger in CNB (0.99) than in FNA (0.94). CNB demonstrated a significantly lower pooled proportion of non-diagnostic (5.5 %; p < .001) and inconclusive results (8.0 %; p < .001) than FNA (22.6 %, 40.2 %, respectively). The complications rate of FNA (0.0 %) was lower than that of CNB (0.01 %), although not significantly (p = .948). This meta-analysis showed variable heterogeneities, i.e., no heterogeneity to considerable heterogeneity. Additional meta-analyses based on three, homogeneous inclusion criteria demonstrated that heterogeneities were reduced, and the results are in agreement with those of all of the included studies. Subgroup analyses have explained the cause of heterogeneity across studies. Both CNB and FNA may be acceptable diagnostic tools for diagnosing thyroid malignancy. CNB may be a complementary diagnostic tool in nodules with initially non-diagnostic and indeterminate results on previous FNA.

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Diagnosis of Thyroid Follicular Neoplasm: Fine-Needle Aspiration Versus Core-Needle Biopsy

Abstract: CNB showed a significantly lower false-positive rate and a higher malignancy rate than FNA in diagnosing FN. Therefore, CNB could minimize unnecessary surgery and provide diagnostic confidence when managing patients with FN to perform surgery.

Cited by 54 publications

References 23 publications

Role of Core Needle Biopsy in the Management of Atypia/Follicular Lesion of Undetermined Significance Thyroid Nodules: Comparison with Repeat Fine-Needle Aspiration in Subcategory Nodules

Role of Core Needle Biopsy in the Management of Atypia/Follicular Lesion of Undetermined Significance Thyroid Nodules: Comparison with Repeat Fine-Needle Aspiration in Subcategory Nodules

FGFR2 in gastric cancer: protein overexpression predicts gene amplification and high H-index predicts poor survival

The role of core-needle biopsy in the diagnosis of thyroid malignancy in 4580 patients with 4746 thyroid nodules: a systematic review and meta-analysis

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