Thin core biopsy should help to discriminate thyroid nodules cytologically classified as indeterminate. A new sampling technique

Abstract

Indeterminate neoplasms (IN) represent the gray zone of thyroid cytology in which malignant and benign tumors cannot be discriminated. Recently, the approach by thin core needle biopsy has been proposed. Here we report a new thin core needle biopsy approach in 40 consecutive patients with thyroid IN at cytology. In this study, a 21-G needle was inserted into the nodule, advanced within the lesion, and moved ahead reaching extranodular tissue. The resulting sample allowed to evaluate the cytomorphology of nodular tissue, its relationship with extranodular parenchyma, and the nodule's capsule when present. All biopsies were adequate for diagnosis but one. Of the 39 adequate samples, 5 cases were papillary cancer as confirmed at histology, while 14 nodules avoided surgery because of Hürthle cell hyperplasia in thyroiditis (n = 6) and microfollicular adenomatous hyperplasia (n = 8). The remaining 20 cases were assessed as follicular neoplasms because of encapsulation and were evaluated by immunohistochemistry. Of these, 6 had positive markers in different degree and 1/6 has follicular cancer at histology, while the other 14 were benign after surgery. Overall, this approach by thin core needle biopsy identified benignancy in 14/40 (35 %) IN avoiding surgery. As a conclusion, thin core biopsy should help to discern the nature of thyroid lesions cytologically classified as indeterminate, and it should be used as a complementary test in thyroid nodule assessment.

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

“…18 These problematic nodules should be diagnosed on US before any intervention. Circumscribed solid nodules without malignant features are considered an indeterminate category on US.…”

“…One recent study suggested that the use of a CNB technique that biopsied the capsule of the thyroid nodule and the surrounding parenchyma was useful for the diagnosis of cytologically indeterminate nodules. 18 However, the authors did not compare the results of the conventional method with those of the modified method or focus on the diagnosis of problematic nodules by using a conventional CNB method. We evaluated whether the modified CNB technique was more effective in the diagnostic yield of circumscribed solid nodules without malignant sonographic features with indeterminate cytology compared with a conventional method.…”

BRAF mutation assessment in papillary thyroid cancer: are we ready to use it in clinical practice?

“…The latter cytological picture occurs quite frequently (10-26 % of nodules) and harbors an intermediate risk of malignancy (14-48 %). Improvements of thyroid cytopathology by the introduction of thin core needle biopsy, with the assessment of the nodule capsule and the perinodular tissue, have appeared to ameliorate recognition of malignancy in cytologically indeterminate nodules [9]. Similarly, combination of nodule ultrasound features with measures of nodule stiffness, obtained by real-time elastography, has appeared to increase sensitivity for malignancy and to strengthen the selection of patients who do not need further diagnostic testing [10].…”

Neck schwannoma diagnosed by core needle biopsy: a case report

“…Firstly, it helped us to rule out a possible metastatic thyroid disease which would have driven to completely different diagnostic and therapeutic choices, with no preliminary open surgical biopsy of the lymph node needed, provided it had been adequately evaluated by CNB. Besides, CNB of the neck lesion was performed by a 21-gauge needle, which in other papers concerning thyroid biopsy proved to have a good tolerability by patients [15], with low complication rates [5]. Focusing on soft tissue tumors, in our opinion more studies would be necessary in order to establish the proper role of CNB within the diagnostic work-up [16].…”

“…Thus, we decided to perform a core needle biopsy (CNB) of the neck mass. After administration of local anesthesia by mepivacain 1 % mL, a 21-gauge modified Menghini cutting needle (Biomol Ò , Hospital Service, Rome, Italy) was percutaneously introduced under ultrasound guide in freehand fashion, as recently described for thyroid lesions [5] (Fig. 1b).…”