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

Abstract

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.

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

“…In a meta-analysis by Suh et al (95), both CNB and FNA showed high specificity (99% vs. 100%) for the diagnosis of thyroid malignancy. However, CNB demonstrated a significantly lower pooled proportion of non-diagnostic (5.5%, p < 0.001) and inconclusive (8.0%, p < 0.001) results than FNA (22.6% and 40.2%, respectively) and higher sensitivity (91% vs. 74%, p = 0.053).…”

“…Regarding the diagnostic accuracy of thyroid malignancy, a meta-analysis by Suh et al (95) compared the results of 12 CNB studies (2122454756575969859699100) with those of 6 FNA studies (224556575996). The specificities of both CNB and FNA were very high (both 99.5%) but the sensitivity was higher for CNB (74% [95% confidence interval, 67–81%] vs. 50% [95% confidence interval, 44–56%]).…”

Endocrine surgery: Diagnostic tools with doubtful findings, and rare tumors of the adrenal gland

“…The current strategy for non-diagnostic FNA results for nodules that are suspicious on ultrasound (US), is not to operate immediately, but to repeat the FNA within a month. Another interesting finding of the above study was the low specificity of FNA, although it has been reported above 85% in multiple recent studies [2].…”

Fine needle aspirates of kidneys: a promising tool for RNA sequencing in native and transplanted kidneys

“…Currently percutaneous FNA is often performed for cancer diagnosis in various solid organs, such as breast, liver, and thyroid gland as well as in accessible lymph nodes [18]. FNAs are much easier to perform than core needle biopsies and are associated with significantly fewer complications.…”

“…FNAs are much easier to perform than core needle biopsies and are associated with significantly fewer complications. A recent metaanalysis of more than 4500 patients undergoing core-needle biopsy and/or FNA for thyroid cancer diagnosis reported an essentially 0 % complication rate [18]. In addition, cessation of oral anticoagulation or anti-platelet agents might not be necessary before fine needle aspiration [19, 20].…”