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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The scientific guarantor of this publication is Jose Luis del Cura.
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Written informed consent was obtained from all subjects (patients) in this study, to perform the procedures described in it.
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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