Thyroid core needle biopsy: taking stock of the situation

Trimboli, Pierpaolo; Crescenzi, Anna

doi:10.1007/s12020-014-0382-z

Cited by 33 publications

(27 citation statements)

References 51 publications

(122 reference statements)

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“…These last years, several singleinstitution articles reported the use of CNB as a secondline approach in these thyroid lesions with prior inadequate or indeterminate cytology (49). Data from these papers are interesting and, more recently, this option was included in thyroid AACE/AME/European Thyroid Association (ETA) guidelines and Italian consensus for thyroid cytology (8,48).…”

Section: Core Needle Biopsymentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: High-yield thyroid fine-needle aspiration cytology: an update focused on ancillary techniques improving its accuracy

Bongiovanni

Trimboli

Rossi

et al. 2016

European Journal of Endocrinology

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Thyroid fine-needle aspiration (FNA) cytology is a fast growing field. One of the most developing areas is represented by molecular tests applied to cytological material. Patients that could benefit the most from these tests are those that have been diagnosed as 'indeterminate' on FNA. They could be better stratified in terms of malignancy risk and thus oriented with more confidence to the appropriate management. Taking in to consideration the need to improve and keep high the yield of thyroid FNA, professionals from various fields (i.e. molecular biologists, endocrinologists, nuclear medicine physicians and radiologists) are refining and fine-tuning their diagnostic instruments. In particular, all these developments aim at increasing the negative predictive value of FNA to improve the selection of patients for diagnostic surgery. These advances involve terminology, the application of next-generation sequencing to thyroid FNA, the use of immunocyto-and histo-chemistry, the development of new sampling techniques and the increasing use of nuclear medicine as well as molecular imaging in the management of patients with a thyroid nodule. Herein, we review the recent advances in thyroid FNA cytology that could be of interest to the 'thyroid-care' community, with particular focus on the indeterminate diagnostic category.

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Section: Core Needle Biopsymentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: High-yield thyroid fine-needle aspiration cytology: an update focused on ancillary techniques improving its accuracy

Bongiovanni

Trimboli

Rossi

et al. 2016

European Journal of Endocrinology

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“…Previous systematic reviews and meta-analyses also suggested different opinion [32][33][34]. One meta-analysis, which included only five articles, concluded that FNA and CNB do not differ significantly in terms of their sensitivity and specificity for diagnosing thyroid cancer [32].…”

Section: Introductionmentioning

confidence: 99%

“…However, the included studies were heterogeneous and with different inclusion and diagnostic criteria for diagnosing malignancy and the patients in two of these studies partially overlapped [15,35]. Trimboli et al [33] concluded that CNB has been reported as more accurate than FNA for diagnosing thyroid nodules, especially thyroid nodules with previously reported inadequate or indeterminate cytology. Yoon et al [34] reported that CNB may have a complementary role, not an alternative role, to FNA, especially for nodules with an inconclusive diagnosis as it provides a definite diagnosis that helps triage patients who require surgery and thereby minimizes the number of unnecessary invasive procedures.…”

Section: Introductionmentioning

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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“…While Galectin-3 panel was applied on several cytologic preparations (i.e., cell block or liquid-based) from nodule's aspiration [6][7][8], these markers have not been investigated in thyroid microhistologic samples from core needle biopsy (CNB). By CNB samples, a large percentage of nodules that are read as indeterminate at FNAC may be re-assessed as diagnostic, with high tolerability and good comfort for patients [9]. Then, CNB has been recently described as an accurate complementary test in those thyroid lesions with prior not conclusive FNAC [10][11][12][13][14], and is included in current guidelines for those nodules with prior inadequate cytologic report [1].…”

Section: Introductionmentioning

confidence: 99%

Galectin-3 and HBME-1 improve the accuracy of core biopsy in indeterminate thyroid nodules

et al. 2015

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Core needle biopsy (CNB) has been recently described as an accurate second-line test in thyroid inconclusive cytology (FNA). Here we retrospectively investigated the potential improvement given by Galectin-3, Cytokeratin-19, and HBME-1 on the accuracy of CNB in thyroid nodules with prior indeterminate FNA report. The study included 74 nodules. At CNB diagnosis, 15 were cancers, 40 were benign, and 19 had uncertain/non-diagnostic CNB report. The above immunohistochemical (IHC) panel was analyzed in all cases. After surgery, 19 malignant and 55 benign lesions were found. All 15 cancers and all 40 benign nodules diagnosed at CNB were confirmed at final histology. Regarding the uncertain CNB group, 4 (21 %) were malignant and 15 (79 %) benign. When we considered all the series, the most accurate IHC combination was Galectin-3 plus HBME-1, while HBME-1 was the most sensitive marker in those nodules with uncertain CNB report. The combination of CNB plus IHC could indentify 19/19 cancers and 53/55 benign lesions. Sensitivity and specificity of CNB increased from 79 to 100 % and from 73 to 96 %, respectively, by adding IHC. CNB can diagnose the majority of thyroid nodules with previous indeterminate FNA cytology, while the accuracy of CNB is increased by adding Galectin-3, Cytokeratin-19, and HBME-1 panel. We suggest to adopt CNB as a second-line approach to indeterminate thyroid FNA, and apply IHC in those lesions with uncertain/non-diagnostic CNB report. This approach should improve the pre-surgical diagnosis of patients. These results should be confirmed in larger prospective series.

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Thyroid core needle biopsy: taking stock of the situation

Cited by 33 publications

References 51 publications

DIAGNOSIS OF ENDOCRINE DISEASE: High-yield thyroid fine-needle aspiration cytology: an update focused on ancillary techniques improving its accuracy

DIAGNOSIS OF ENDOCRINE DISEASE: High-yield thyroid fine-needle aspiration cytology: an update focused on ancillary techniques improving its accuracy

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

Galectin-3 and HBME-1 improve the accuracy of core biopsy in indeterminate thyroid nodules

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