Comparison of Pre-Operation Diagnosis of Thyroid Cancer with Fine Needle Aspiration and Core-needle Biopsy: a Meta-analysis

Abstract

Background:The aim of this meta-analysis was to compare sensitivities and specificities of fine needle aspiration (FNA) and core needle biopsy (CNB) in the diagnosis of thyroid cancer. Materials and Methods: Articles were screened in Medline, the Cochrane Library, EMBASE and Google Scholar, and subsequently included and excluded based on the patient/problem-intervention-comparison-outcome (PICO) principle. Primary outcome was defined in terms of diagnostic values (sensitivity and specificity) of FNA and CNB for thyroid cancer. Secondary outcome was defined as the accuracy of diagnosis. Compiled FNA and CNB results from the final studies selected as appropriate for meta-analysis were compared with cases for which final pathology diagnoses were available. Statistical analyses were performed for FNA and CNB for all of the selected studies together, and for individual studies using the leave-one-out approach. Results: Article selection and screening yielded five studies for meta-analysis, two of which were prospective and the other three retrospective, for a total of 1,264 patients. Pooled diagnostic sensitivities of FNA and CNB methods were 0.68 and 0.83, respectively, with specificities of 0.93 and 0.94. The areas under the summary ROC curves were 0.905 (±0.030) for FNA and 0.745 (±0.095) for CNB, with no significant difference between the two. No one study had greater influence than any other on the pooled estimates for diagnostic sensitivity and specificity. Conclusions: FNA and CNB do not differ significantly in sensitivity and specificity for diagnosis of thyroid cancer.

Fine-needle aspiration versus core needle biopsy for diagnosis of thyroid malignancy and neoplasm: a matched cohort study

“…A recent meta-analysis by Li et al [20] found that FNA and CNB do not differ significantly in sensitivity and specificity for diagnosis of thyroid malignancy, concordant with our results. The areas under the ROC curves of FNA were even higher than those of CNB without statistical significance (0.905 ± 0.030 for FNA vs. 0.745 ± 0.095, for CNB, P = 0.053) [20].…”

“…The areas under the ROC curves of FNA were even higher than those of CNB without statistical significance (0.905 ± 0.030 for FNA vs. 0.745 ± 0.095, for CNB, P = 0.053) [20]. This meta-analysis included the aforementioned study by Sung et al along with four other studies [6,9,18,19,21].…”

“…Therefore, our results found that there may be no benefit in performing CNB over FNA, given the two methods show comparable diagnostic performances. Until now, only a few studies have compared the diagnostic performances of CNB with those of FNA in the diagnosis of thyroid malignancy [6,9,[18][19][20][21]. Of these prior studies, the study by Sung et al evaluated 555 thyroid nodules, the largest number with regard to sample size, and used the same diagnostic criteria as our criterion 1 to calculate diagnostic performances [9].…”

“…The results of these studies have not been consistent: CNB was more accurate and sensitive than FNA in some studies [6,9,21], but other studies, including one meta-analysis, showed that CNB had similar or rather lower accuracy and sensitivity compared to FNA [18][19][20]. If the diagnostic accuracy does not significantly differ between the two methods, there may be no benefit in performing CNB in spite of accepting risk of complications and technical difficulty, which are more common with CNB than with FNA.…”

“…A few limited studies have compared the diagnostic accuracy of ultrasound (US)-guided CNB with that of US-guided FNA in the diagnosis of malignancy [6,9,[18][19][20][21]. The results of these studies have not been consistent: CNB was more accurate and sensitive than FNA in some studies [6,9,21], but other studies, including one meta-analysis, showed that CNB had similar or rather lower accuracy and sensitivity compared to FNA [18][19][20].…”