The use of core needle biopsy as first-line in diagnosis of thyroid nodules reduces false negative and inconclusive data reported by fine-needle aspiration

Abstract

BackgroundThe reported reliability of core needle biopsy (CNB) is high in assessing thyroid nodules after inconclusive fine-needle aspiration (FNA) attempts. However, first-line use of CNB for nodules considered at risk by ultrasonography (US) has yet to be studied. The aim of this study were: 1) to evaluate the potential merit of using CNB first-line instead of conventional FNA in thyroid nodules with suspicious ultrasonographic features; 2) to compare CNB and FNA as a first-line diagnostic procedure in thyroid lesions at higher risk of cancer.MethodsSeventy-seven patients with a suspicious-appearing, recently discovered solid thyroid nodule were initially enrolled as study participants. No patients had undergone prior thyroid fine-needle aspiration/biopsy. Based on study design, all patients were proposed to undergo CNB as first-line diagnostic aspiration, while those patients refusing to do so underwent conventional FNA.ResultsFive patients refused the study, and a total of 31 and 41 thyroid nodules were subjected to CNB and FNA, respectively. At follow-up, the overall rate of malignancy was of 80% (CNB, 77%; FNA, 83%). However, the diagnostic accuracy of CNB (97%) was significantly (P < 0.05) higher than that of FNA (78%). In one benign lesion, CNB was inconclusive. Four (12%) of the 34 cancers of the FNA group were not initially diagnosed because of false negative (N = 1), indeterminate (N = 2) or not adequate (N = 1) samples.ConclusionsCNB can reduce the false negative and inconclusive results of conventional FNA and should be considered a first-line method in assessing solid thyroid nodules at high risk of malignancy.

Thyroid core needle biopsy: taking stock of the situation

“…This finding was perfectly in agreement with that previous reported by papers analyzing the likelihood for malignancy in these specific nodules [46][47][48]. More recently, CNB or conventional FNAC was proposed to patients with newly discovered at risk thyroid lesions [24]; the diagnostic accuracy of CNB was significantly higher than that of FNAC [24]. These data should prompt to use CNB in those nodules suspected to be a cancer to avoid false negative FNAC reports, but more studies, ideally with prospective design and multicenter setting, are needed.…”

“…Use of CNB in specific ultrasonographic presentations of thyroid nodules or in patients with peculiar clinical contexts Few papers evaluated the diagnostic utility of CNB with ultrasound risk presentation [23][24][25][26]. As the first, Ha et al [23] used CNB in thyroid nodules with previous benign FNAC outcome but having high risk at ultrasound examination.…”

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

“…However, there are currently no definite guidelines describing how CNB should be used to diagnose thyroid nodules, and there is insufficient evidence for comparing it with FNA. Moreover, recently published articles suggested different opinion for the role of CNB [23,32,34]. In our current study, we determined the pooled proportion of non-diagnostic and inconclusive results using CNB and FNA using more recently developed statistical methods of combining the studies, i.e., the HSROC model or the bivariate random effects model.…”

“…Of these 35 articles, 15 were further excluded after reviewing the full text, i.e., three studies that did not use US-guided, spring-activated CNB [43][44][45], two studies that used CNB under palpation guidance [29,46], seven studies that were not in the field of interest [31,[47][48][49][50][51][52], and three studies with a partially overlapping patient cohort [35,38,53]. Finally, 20 eligible studies, which included a total sample size of 4580 patients and 4746 thyroid nodules, were included in this metaanalysis [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

“…Core-needle biopsy (CNB) has been suggested as an alternative to FNA [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] in order to resolve these limitations. In the past two decades, many studies have described the role of CNB which is known to be a feasible, effective, and well-tolerated biopsy procedure that has a low incidence of complications [27,28].…”