Comparison of diagnostic yield of core-needle and fine-needle aspiration biopsies of thyroid lesions: Systematic review and meta-analysis

Abstract

ObjectivesThyroid nodular disease is one of the most commonly observed medical conditions. Cytological evaluation of the specimens obtained with fine-needle aspiration biopsy (FNAB) is the most accurate tool for selecting nodules which should be further surgically removed. A major limitation of this method is the high occurrence of non-diagnostic results. This indicates the need for improvement of the thyroid biopsy technique. The aim of this meta-analysis was to compare the diagnostic value of thyroid core-needle biopsies (CNBs) and FNABs.Materials and methodsPubMed/MEDLINE, Cochrane Library, Scopus, Cinahl, Academic Search Complete, Web of Knowledge, PubMed Central, PubMed Central Canada and Clinical Key databases were searched. Risk ratios (RRs) of non-diagnostic results were meta-analysed using the random-effects model.ResultsEleven studies were included in the quantitative analysis. CNB yielded significantly more diagnostic results – the pooled risk ratio (RR) of gaining a non-diagnostic result was 0.27 (p<0.0001). For lesions with one previous non-diagnostic FNAB, RR was 0.22 (p<0.0001).ConclusionsCNB seems to be a valuable diagnostic technique yielding a higher proportion of diagnostic results than conventional FNAB. It is also significantly more effective in case of nodules with a prior non-diagnostic result of FNAB results than repeated FNABs.Key Points• Core-needle biopsy yields a higher proportion of diagnostic results than fine-needle biopsy. • Core-needle biopsies may decrease the amount of unnecessary thyroidectomies. • Probability of gaining non-diagnostic result using core-needle biopsy is almost four times lower.

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

“…In recent systematic review and meta-analysis studies, CNB is suggested as an effective diagnostic tool to reduce inconclusive results in thyroid nodules with previously non-diagnostic FNA result (62636465). In these studies, CNB showed lower non-diagnostic or inconclusive results than repeat FNA.…”

Prediction of follicular thyroid carcinoma associated with distant metastasis in the preoperative and postoperative model

“…The formulation of the Bethesda system for cytology and the use of core needle biopsy have improved the diagnostic accuracy for follicular neoplasm . Predicting factors associated with metastasis in patients diagnosed with follicular neoplasm are helpful in determining the appropriate timing of surgery.…”

Value of biomarkers in distinguishing indeterminate core needle biopsy samples of thyroid nodules

“…Compared to resected specimens, the diagnoses of biopsies are more challenging. The indeterminate rate of diagnosis is reported to be 10%-40% for FNB and 5%-20% for CNB[5]. Our comparative study between CNB and resected specimens of thyroid nodules showed that 74 of 578 cases were unable to be determined as malignant or benign based on CNB sample morphology alone[6].…”

“…In this case, the advantage of CNB for obtaining a large amount of tissue and providing more information on histological structures is highlighted. Published studies have shown that the accuracy of CNB for the preoperative diagnosis of thyroid nodules was higher than that of FNB [5]. However, approximately 5%-20% of CNB samples are classified as indeterminate based on morphology alone [5,6].…”

“…Published studies have shown that the accuracy of CNB for the preoperative diagnosis of thyroid nodules was higher than that of FNB [5]. However, approximately 5%-20% of CNB samples are classified as indeterminate based on morphology alone [5,6]. Compared to FNB, samples collected by CNB are more accessible for various testing methods.…”