Histological Diagnosis of Thyroid Disease Using Ultrasound-Guided Core Biopsies

Abstract

Background: Thyroid core biopsies obtained with ultrasound (US)-guided needles are an alternative to conventional fine-needle aspiration and, according to various authors, have greater sensitivity and specificity. The technique is inexpensive, rapid and reliable with a low rate of complications, similar to conventional fine-needle aspiration procedures. Objectives: This paper critically reviews the methodology for obtaining samples and processing them in the pathology laboratory. Methods: Accumulated experience with 1,065 cases of US-guided core biopsy of the thyroid gland in a 15-year period. Results: US-guided core biopsy is a useful, inexpensive and safe method in the histological diagnosis of thyroid gland pathology. Thyroid samples obtained this way are not a substitute for fine-needle aspiration cytology. Indeed, some authors assert that the best results are obtained by combining the two approaches, the methods being complementary. Conclusions: To take best advantage of the findings from these techniques, pathologists must know which types of diagnoses can be made and the fundamentals of how and, lastly, what cannot be diagnosed and the reasons why. Best results are obtained with a multidisciplinary approach in a hospital committee composed of endocrinologists, surgeons, radiologists and pathologists, who analyse and provide a background on each case.

Core‐needle biopsy versus repeat fine‐needle aspiration for thyroid nodules initially read as atypia/follicular lesion of undetermined significance

“…Second, CNB provides more information about the histological architecture and relationship between the nodule and the adjacent thyroid tissue; this factor may also be a major cause for the higher rate of FN/SFN diagnosis using CNB noted in our present study. Third, CNB demonstrates less operator dependency if the needle successfully penetrates the nodule …”

“…Third, CNB demonstrates less operator dependency if the needle successfully penetrates the nodule. 27,54 There have been several studies that identified the risk factors that affect nondiagnostic FNA results 55,56 and the risk factors associated with second nondiagnostic results. 34 However, there have been no previous reports on the risk factors associated with inconclusive results obtained using second ultrasound-guided biopsy to assess thyroid nodules with initial AUS/FLUS results.…”

Core Needle Biopsy of the Thyroid: 2016 Consensus Statement and Recommendations from Korean Society of Thyroid Radiology

“…Although a device with a strong spring can better penetrate hard tissues such as calcifications or fibrosis, it has higher potential for injury of normal tissue or vessels. The amount of tissue obtained depends on the needle thickness and the length of the specimen notch (51). …”

“…Our society recommends a free-hand technique because it allows greater freedom, permitting the operators both to select the puncture point and to adjust the route during the procedure (51). Before the procedure, the nodule size, position, characteristics, and vascularity should be evaluated by gray-scale and color Doppler US.…”

“…When a successive method is used, the location of the specimen notch can be adjusted after stylet firing to select the most appropriate sampling site. For pathological interpretation, the three following components should be obtained: nodule tissue, nodule-parenchyma border (sometimes there is a visible capsule), and normal thyroid parenchyma (4651). While adjusting the specimen notch position, blood can rapidly fill the specimen notch if there is a hypervascular nodule.…”