Core needle biopsy of thyroid nodules: outcomes and safety from a large single-center single-operator study

Abstract

Background There currently remains a debate over the use of core needle biopsy (CNB) or fine needle aspiration (FNA) for diagnosis of thyroid nodules. The major drawbacks of previous CNB studies include heterogeneity of the study population, variable techniques, devices, and operator experience affecting the outcome of the procedure. Purpose To assess the diagnostic performance and safety of CNB of thyroid nodules performed by a single experienced operator in consecutive patients. Material and Methods From January 2012 to December 2012, 538 thyroid nodules that underwent CNB were retrospectively evaluated. All CNB procedures were performed by a single operator with 18 years of experience. The histopathology of the surgical specimens was considered as the standard reference for malignancy. A final diagnosis of benignity was made by surgery, one benign lesion on FNA and/or CNB with no change on follow-up examinations (>1 year) or benign lesion on ≥2 FNA and/or CNB. The diagnostic performance, incidence of technical failure, unnecessary surgery, and complication were evaluated. Results The diagnostic accuracy, sensitivity, and specificity of CNB for malignancy were 92.0%, 85.3%, and 100%, respectively. The non-diagnostic result rate of CNB was 4.8% (26/538) and the inconclusive result rate was 24.3% (131/538). The incidence of technical failure was 0.6% (3/541) and unnecessary surgery was 0.6%. The complication rate was 0.2%, without life-threatening complications. The sensitivity, specificity, and accuracy were 85.3% (156/183), 100.0% (154/154), and 92.0% (310/337), respectively. Conclusion CNB shows a high diagnostic performance for detection of thyroid malignancy and follicular neoplasm, with low rates of technical failure and complications.

The KWAK TI‐RADS and 2015 ATA guidelines for medullary thyroid carcinoma: Combined with cell block‐assisted ultrasound‐guided thyroid fine‐needle aspiration

“…Compared with FNA, CNB can obtain more pathological specimens with higher diagnostic accuracy and can provide relevant immunohistochemical and histological information . However, CNB is associated with a risk of injury to peripheral tissues (such as nerves and blood vessels) and tumour needle implantation . Unlike conventional nonvacuum FNA, CB‐assisted FNA requires vacuum aspiration by an injection syringe to obtain satisfactory samples.…”

Comparison Between Fine Needle Aspiration and Core Needle Biopsy for the Diagnosis of Thyroid Nodules: Effective Indications According to US Findings

“…In particular, with CNB, the main concerns most commonly include bleeding and hematoma 24,25 . The CNB complication rates have been reported between 0.2% and 1.0% [25][26][27][28] , and patient discomfort and tolerability levels were not significantly different between FNA and CNB 28,29 . Fortunately, in our results, the superiority of CNB to FNA was apparent in nodules more than 2 cm with US findings categorized as intermediate suspicion.…”

Usage and Diagnostic Yield of Fine-Needle Aspiration Cytology and Core Needle Biopsy in Thyroid Nodules: A Systematic Review and Meta-Analysis of Literature Published by Korean Authors

“…Eight papers [24,36,39,40,42,44,51,55] were excluded because their study periods overlapped with those of other papers reporting data from the same hospital; thus, the analysis included 28 papers. Five papers reported diagnostic findings for both CNB and FNA [30,33,43,54,56], while four papers [23,26,27,31] reported CNB results only. Interval for repeated biopsy in nodules with initially non-diagnostic results: 6 months will be safe FNA, fine-needle aspiration; CNB, core needle biopsy.…”