Ultrasound-Guided Percutaneous Thyroid Nodule Core Biopsy: Clinical Utility in Patients with Prior Nondiagnostic Fine-Needle Aspirate

Abstract

Background: Five percent to 20% of thyroid nodule fine-needle aspiration (FNA) samples are nondiagnostic. The objective of this study was to determine whether a combination of FNA and core biopsy (CFNACB) would yield a higher proportion of diagnostic readings compared with FNA alone in patients with a history of one or more prior nondiagnostic FNA readings. Methods: We conducted a retrospective study of 90 core biopsies (CBs) performed in 82 subjects (55 women and 27 men) between 2006 and 2008 in an outpatient clinic. Results: CFNACB yielded a diagnostic reading in 87%. The diagnostic reading yield of the CB component of CFNACB was significantly superior to the concurrent FNA component, with CB yielding a diagnosis in 77% of cases and FNA yielding a diagnosis in 47% ( p < 0.0001). The combination of CB and FNA had a higher diagnostic reading yield than either alone. In 69 nodules that had only one prior nondiagnostic FNA, CB was diagnostic in 74%, FNA was diagnostic in 52%, CFNACB was diagnostic in 87%, and CB performed significantly better than FNA ( p = 0.0135). In 21 nodules with two or more prior nondiagnostic FNAs, CFNACB and CB were diagnostic in 86%, FNA was diagnostic in 29%, and CB was significantly better than FNA ( p = 0.0005). Clinical, ultrasound, or histopathologic follow-up was available for 81% (73/90) of the CFNACB procedures. No subject with a benign CFNACB reading was diagnosed with thyroid malignancy in the follow-up period (range 4-37 months, mean 18 months), although one subject had minimal increase in nodule size and was awaiting repeat sonography at study conclusion. Conclusion: Thyroid nodule CFNACB is safe and clinically useful in selected patients when a prior FNA reading is nondiagnostic. CFNACB is superior to either CB or FNA alone. CFNACB should be strongly considered as an alternative to surgery in individuals with two prior nondiagnostic FNAs.

Modified Core Biopsy Technique to Increase Diagnostic Yields for Well-Circumscribed Indeterminate Thyroid Nodules: A Retrospective Analysis

“…[7][8][9]19 These studies reported that the rate of inconclusive CNB results ranged between 0% and 26%. Recently, Hahn et al 5 demonstrated that US-CNB is beneficial for the diagnosis of thyroid nodules with inconclusive US-guided FNA results.…”

“…2,3 Several studies have suggested that sonography-guided core needle biopsy (US-CNB) helps decrease the frequency of inconclusive diagnostic results and improves the rate of accurate diagnoses. [5][6][7][8][9] US-CNB is safe and well-tolerated, yields a low incidence of complications, and serves as an alternative to FNA for obtaining tissues for diagnosis. 7,10 However, its results have remained indeterminate for up to 36% of the nodules whose cytology is insufficient to differentiate nodular hyperplasia from follicular neoplasm, even after US-CNB.…”

The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions

“…Because US-guided CNB using a spring-activated biopsy needle has been reported safe and effective by Quinn et al, 23 several investigators have demonstrated the usefulness of CNB in diagnosing thyroid nodules with 90.3% (range, 78.5%-100%) sensitivity and 98.4% (range, 87%-100%) positive predictive value for thyroid malignancy. [18][19][20][24][25][26] Currently, the role of CNB has focused on the diagnosis of nodules with previously nondiagnostic results on FNA and, therefore, on preventing unnecessary diagnostic surgery. 19,24,25,27 For the diagnosis of a specific type of malignancy, however, CNB has also showed the possibility of superior diagnostic performance to that of FNA for thyroid lymphoma, anaplastic carcinoma, and metastasis in a small series of studies.…”

Comparison of Fine-Needle Aspiration and Core Needle Biopsy under Ultrasonographic Guidance for Detecting Malignancy and for the Tissue-Specific Diagnosis of Salivary Gland Tumors

“…For example, US guidance can increase the diagnostic performance of FNA compared with palpation guidance, as evidenced in the diagnosis of thyroid nodules. 9 Core needle biopsy (CNB) under US guidance is used frequently for masses in the head and neck area [10][11][12] and has several advantages over either palpation-guided or US-guided FNA, including the ability to obtain a larger specimen with preserved tissue architecture for possible immunohistochemical staining. This potentially contributes to the low nondiagnostic rate and high average sensitivity (92%) and specificity (100%) of this procedure, with little variation in its ability to detect malignant tumors in salivary glands.…”