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Core-needle biopsy in thyroid nodules: performance, accuracy, and complications

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Abstract

Objective

To evaluate the performance of core-needle biopsy (CNB) in thyroid using a cohort of patients in which it was used as first choice.

Methods

Our institutional review board approved this retrospective study. We reviewed all CNB performed in our center over a period of 11 years. Ultrasound-guided CNBs were performed using a spring-loaded 18-gauge biopsy needle. We used a classification with four diagnostic categories for CNB results: insufficient, benign, follicular lesion (indeterminate), and malignant. Final diagnosis was based on surgical diagnosis or follow-up of at least 2 years in non-operated patients.

Results

The study included 4412 CNB in 4112 nodules of 3768 patients, 300 of them repeated biopsies. Results were 148 insufficient (3.4%), 3706 benign (84%), 278 follicular lesions (6.3%), and 280 malignant (6.3%). Considering follicular lesion and malignancy CNB results as positive (both lead to the recommendation of surgery) sensitivity was 96% (CI 93.2–97.8) and specificity 93.7% (CI 92.9–94.5). Predictive positive value for a follicular lesion diagnosis was 12.2% and for a malignancy diagnosis, 98.6%. CNB likelihood ratio for malignancy of a malignant diagnosis was 841.9 (CI 315.8–2313.3), of a malignant/follicular lesion diagnosis was 23.4 (CI 20.1–27.3), and of a benign diagnosis was 0.04 (CI 0.02–0.07). Repeated CNB in 53 insufficient biopsies obtained 50 diagnostic results. Minor complications occurred in 2.2% of CNB, and major in four procedures (0.09%).

Conclusions

CNB in thyroid nodules is accurate and has few complications and a low rate of non-diagnostic and indeterminate diagnoses. It can be an alternative method when FNAC has poor performance. Repeating biopsy is useful after non-diagnostic biopsies.

Key Points

• Core-needle biopsy of thyroid has a low ratio non-diagnostic and indeterminate results.

• Core-needle biopsy results are highly reliable, especially benign results.

• Complication rate of core-needle biopsy of thyroid is low.

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Abbreviations

BSRTC:

Bethesda System for Reporting Thyroid Cytopathology

CNB:

Core-needle biopsy

FNAC:

Fine-needle aspiration cytology

PTC:

Papillary thyroid carcinoma

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Funding

The authors state that this work has not received any funding.

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Authors

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Correspondence to Jose Luis del Cura.

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Guarantor

The scientific guarantor of this publication is Jose Luis del Cura.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study, to perform the procedures described in it.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Paja M, del Cura JL, Zabala R, et al (2016) Ultrasound-guided core-needle biopsy in thyroid nodules. A study of 676 consecutive cases with surgical correlation. Eur Radiol 26:1–8.

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• observational

• performed at one institution

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Paja, M., del Cura, J.L., Zabala, R. et al. Core-needle biopsy in thyroid nodules: performance, accuracy, and complications. Eur Radiol 29, 4889–4896 (2019). https://doi.org/10.1007/s00330-019-06038-6

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  • DOI: https://doi.org/10.1007/s00330-019-06038-6

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