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

Abstract

BACKGROUND AND PURPOSE:The results of conventional core biopsy for some thyroid nodules with indeterminate cytology have still remained indeterminate. The aim of this study was to evaluate whether the ultrasonography-guided core needle biopsy technique containing the nodule, capsular portion, and surrounding parenchyma was more effective than a conventional method in enhancing diagnostic yield for circumscribed solid thyroid nodules without malignant sonographic features.

Preoperative differentiation between noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and non-NIFTP

“…Considering NIFTP lacks malignant US features, US‐CNB could be applied to indeterminate thyroid nodules without the evidence of malignant features (i.e., K‐TIRADS categories 3 or 4). A modified CNB technique containing the nodule, capsular portion and surrounding parenchyma is helpful in reducing sampling error and archiving acceptable diagnostic clues of thyroid nodules . Therefore, a risk‐stratified approach requires US characteristics (US features, size of the primary tumour and tumour stability) and patient characteristics (age, comorbidities and compliance with follow‐up plans).…”

“…For non-NIFTP, however, there was no statistical difference in the surgical indication rates between the US-CNB and US-FNA groups. It should be recognized that US-CNB can lead to more surgery in patients with NIFTP, in comparison 37 Therefore, a risk-stratified approach requires US characteristics (US features, size of the primary tumour and tumour stability) and patient characteristics (age, comorbidities and compliance with follow-up plans). What is unique about our results is that malignant biopsy result (Bethesda and CNB diagnostic category VI) was equally most frequent in both US-FNA and US-CNB groups for non-NIFTP nodules.…”

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

“…CNB has been introduced as a complementary method for thyroid nodules because the large amount of specimen obtained can facilitate more detailed histologic evaluation and ancillary immunohistochemical staining (182324). Moreover, Nasrollah et al (46) have suggested a new sampling technique that includes the capsule of the nodule and the surrounding extranodular parenchyma, as well as nodular tissue (75). This technique could allow follicular neoplasm and unencapsulated non-neoplastic nodules to be distinguished by identifying the presence of a fibrous capsule on histologic evaluation.…”

What Is the Ideal Core Number for Ultrasonography-Guided Thyroid Biopsy of Cytologically Inconclusive Nodules?

“…We obtained the second and third specimens according to the modified technique by Han et al 24 In addition, almost all the US-guided CNBs were performed by 2 experienced thyroid radiologists, and all biopsy specimens were reviewed by an expert pathologist. These are essential prerequisites for the successful diagnostic results.…”

“…The second and third biopsy specimens targeted the capsular portion (margin target) of the thyroid nodule to include a suspicious nodule, a capsule if present, and surrounding normal parenchyma (Fig 1). Previ-ously, Han et al 24 recommended the modified CNB technique, including both nodular tissue and the capsule of the nodule and/or extranodular thyroid tissue. We routinely performed USguided CNB for cytologically inconclusive nodules by using this protocol with 3 cores from June 2013.…”