Ultrasound‐guided needle biopsy of large thyroid nodules: Core needle biopsy yields more reliable results than fine needle aspiration

Lee, Hyeon Jin; Kim, Young Joong; Han, Hye Yeon; Seo, Joobeom; Hwang, Cheol Mog; Kim, Keumwon

doi:10.1002/jcu.22721

Cited by 10 publications

(10 citation statements)

References 35 publications

(120 reference statements)

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“…But in nodules larger than 40 mm, a significantly higher inconclusive rate was seen in malignant nodules with FNA while no significant differences were seen between malignant and benign nodules with CNB. High false-negative rates have been reported for FNA in large thyroid nodules ( 23 24 25 26 27 ), leading to more surgeries for diagnostic purposes. Based on our findings, CNB shows potential as a tool that allows clinicians to make more conclusive preoperative diagnoses of large thyroid nodules that can guide clinicians when they are deciding on how to approach patient management.…”

Section: Discussionmentioning

confidence: 99%

Fine Needle Aspiration Cytology vs. Core Needle Biopsy for Thyroid Nodules: A Prospective, Experimental Study Using Surgical Specimen

Kwon

Lee

Hong

et al. 2022

J Korean Soc Radiol

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Purpose To evaluate and compare the diagnostic outcomes of ultrasonography (US)-guided fine needle aspiration (FNA) and core needle biopsy (CNB) performed on the same thyroid nodule using a surgical specimen for direct comparison. Materials and Methods We included 89 thyroid nodules from 88 patients from February 2015 to January 2016. The inclusion criterion was thyroid nodules measuring ≥ 20 mm (mean size: 40.0 ± 15.3 mm). Immediately after surgical resection, FNA and subsequent CNB were performed on the surgical specimen under US guidance. FNA and CNB cytopathologic results on the specimen were compared with the surgical diagnosis. Results Among the 89 nodules, 30 were malignant and 59 were benign. Significantly higher inconclusive rates were seen in FNA for malignant than benign nodules (80.0% vs. 39.0%, p < 0.001). For CNB, conclusive and inconclusive rates did not differ between benign and malignant nodules ( p = 0.796). Higher inconclusive rates were seen for FNA among cancers regardless of US features, and in the subgroup of size ≥ 40 mm (62.5% vs. 22.9%, p = 0.028). Eleven cancers were diagnosed with CNB (36.7%, 11/30), while none was diagnosed using FNA. Conclusion In this experimental study using surgical specimens, CNB showed a potential to provide improved diagnostic sensitivity for thyroid cancer, especially when a conclusive diagnosis is limited with FNA.

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Section: Discussionmentioning

confidence: 99%

Fine Needle Aspiration Cytology vs. Core Needle Biopsy for Thyroid Nodules: A Prospective, Experimental Study Using Surgical Specimen

Kwon

Lee

Hong

et al. 2022

J Korean Soc Radiol

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“…There is something of a debate surrounding the topic of whether size has any relevance to diagnostic accuracy. A number of studies suggest that larger nodules with benign cytology nevertheless harbour a greater risk for malignancy and a higher rate of false‐negative cytology results 21‐24 . Some authors argue that larger size (≥30 mm) may influence clinical decision making because FNA has decreased reliability in such nodules.…”

Section: Discussionmentioning

confidence: 99%

False positive cases in thyroid cytopathology – the experience of a single laboratory and a systematic review

et al. 2021

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Introduction Fine needle aspiration (FNA) is fundamental in the pre‐operative assessment of thyroid nodules. However, the shining success of thyroid FNA is occasionally eclipsed by false positive (FP) cytological diagnoses. We describe our experience regarding FP cytological diagnoses and present a literature review concerning FP rates. Materials and methods We retrospectively analyzed 2031 consecutive cytology reports. FP was defined as a case with “suspicious for malignancy” or “malignant” cytology, whose surgical follow‐up failed to confirm the initial diagnosis of malignancy. We used the PubMed database for the literature review using specific search terms (“thyroid”, “cytology”, “false positive”). Results Out of 2031 FNA reports, 93 cases with “suspicious for malignancy” or “malignant” cytology underwent surgical excision. Histopathology did not confirm malignancy in 10 cases (0.6% FP rate). Nodules with FP cytology were significantly larger (P = 0.0024) than those with with TP (true positive) cytology. A review of 25 publications shows comparable results to ours with some slight differences. The majority of studies achieve a FP rate below 3%. Most FP cytological diagnoses turn out to be non‐neoplastic lesions (nodular hyperplasia, adenomatous nodule, lymphocytic thyroiditis), which combined account for 80.5% of all histological diagnoses. Conclusions Thyroid nodules with FP cytology were larger than nodules with TP cytology. Most studies manage to adhere to the recommended FP rates, or values close to them, with some outliers. Nevertheless, the mean FP rate values are very close to the value recommended by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The FP rate value depends on how one defines true negative cases, which can be either histologically proven benign cases, via a benign clinical course, or by assuming that cytologically benign cases remain as such.

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“…A recent study suggested the superiority of US-guided core needle biopsy over US-guided FNA with lesser false negativity and better sensitivity for large thyroid nodules (≥2.0 cm) to diagnosis thyroid malignancy [25]. An earlier study assessed Figure 2.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of preoperative palpation- versus ultrasound-guided thyroid fine needle aspiration cytology: an observational study

Taha

Al-Thani

El‐Menyar

et al. 2020

Postgraduate Medicine

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Background: Thyroid fine needle aspiration (FNA) is the mainstay for diagnosis of malignancy, and is an integral part of current thyroid nodule assessment. The present study analyzes the diagnostic accuracy of palpation-directed versus ultrasound guided fine-needle aspiration in patients who underwent surgery for thyroid nodules. Methods: A retrospective chart review of all consecutive patients who had FNA biopsy (palpation or ultrasound guided) of thyroid nodules and underwent thyroid gland surgery between 1998 and 2014 was conducted. The FNA findings of the palpation-guided and ultrasound-guided groups were compared for baseline characteristics. Moreover, the diagnostic accuracy of FNA findings and surgical histopathology results were analyzed. Results: A total of 1174 patients were included in the study with a mean age of 46.3 ± 11.7 years and the majority were females (75.5%). Among the study population, 392 (33.4%) patients underwent USguided FNA; 570 (48.6%) had palpation-guided FNA in clinic and no FNA was done in 212 (18%) cases. Patients underwent US-guided FNA were more likely to have suspicion of malignancy (p = 0.001), and had indeterminate findings (p = 0.001). On the other hand, palpation-guided FNA group had significantly higher frequency of benign cytology (p = 0.001). With respect to the suspicion for malignancy as well as malignancy, the US-guided group had a similar diagnostic accuracy in comparison to the palpation group. The proportion of malignancy finding on US-guided FNA (8.9%) was higher than the palpation-guided FNA (6.4%) that had been confirmed on postoperative histopathological examination (p = 0.95). Conclusion: The present study demonstrates higher sensitivity of US-guided thyroid FNA biopsies over palpation-guided FNA for the suspicion of malignancy; however, the accuracy is comparable. Moreover, both groups showed more postoperative malignancy in the benign and unsatisfactory categories than predicted in the Bethesda system. Further prospective studies are needed to underpin a realistic correlation between FNA and final histopathology reports.

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Ultrasound‐guided needle biopsy of large thyroid nodules: Core needle biopsy yields more reliable results than fine needle aspiration

Cited by 10 publications

References 35 publications

Fine Needle Aspiration Cytology vs. Core Needle Biopsy for Thyroid Nodules: A Prospective, Experimental Study Using Surgical Specimen

Fine Needle Aspiration Cytology vs. Core Needle Biopsy for Thyroid Nodules: A Prospective, Experimental Study Using Surgical Specimen

False positive cases in thyroid cytopathology – the experience of a single laboratory and a systematic review

Diagnostic accuracy of preoperative palpation- versus ultrasound-guided thyroid fine needle aspiration cytology: an observational study

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