The use of core needle biopsy as first-line in diagnosis of thyroid nodules reduces false negative and inconclusive data
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RESEARCH
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
The use of core needle biopsy as first-line in diagnosis of thyroid nodules reduces false negative and inconclusive data reported by fine-needle aspiration Pierpaolo Trimboli1†, Naim Nasrollah2†, Leo Guidobaldi3, Silvia Taccogna3, Davide Domenico Cicciarella Modica3, Stefano Amendola1, Francesco Romanelli4, Andrea Lenzi4, Giuseppe Nigri5*, Marco Centanni4,6, Luca Giovanella7, Stefano Valabrega5 and Anna Crescenzi3
Abstract Background: The reported reliability of core needle biopsy (CNB) is high in assessing thyroid nodules after inconclusive fine-needle aspiration (FNA) attempts. However, first-line use of CNB for nodules considered at risk by ultrasonography (US) has yet to be studied. The aim of this study were: 1) to evaluate the potential merit of using CNB first-line instead of conventional FNA in thyroid nodules with suspicious ultrasonographic features; 2) to compare CNB and FNA as a first-line diagnostic procedure in thyroid lesions at higher risk of cancer. Methods: Seventy-seven patients with a suspicious-appearing, recently discovered solid thyroid nodule were initially enrolled as study participants. No patients had undergone prior thyroid fine-needle aspiration/biopsy. Based on study design, all patients were proposed to undergo CNB as first-line diagnostic aspiration, while those patients refusing to do so underwent conventional FNA. Results: Five patients refused the study, and a total of 31 and 41 thyroid nodules were subjected to CNB and FNA, respectively. At follow-up, the overall rate of malignancy was of 80% (CNB, 77%; FNA, 83%). However, the diagnostic accuracy of CNB (97%) was significantly (P < 0.05) higher than that of FNA (78%). In one benign lesion, CNB was inconclusive. Four (12%) of the 34 cancers of the FNA group were not initially diagnosed because of false negative (N = 1), indeterminate (N = 2) or not adequate (N = 1) samples. Conclusions: CNB can reduce the false negative and inconclusive results of conventional FNA and should be considered a first-line method in assessing solid thyroid nodules at high risk of malignancy. Keywords: Thyroid cancer, Core needle biopsy (CNB), Ultrasonography, Fine-needle aspiration (FNA)
Background Ultrasound (US) examination is the standard method for stratifying risk for malignancy in both palpable and nonpalpable thyroid lesions, thus determining the need for fine-needle aspiration (FNA) [1,2]. A number of publications attest to the specific features by US and color flow Doppler (CFD) that are suggestive of malignancy, * Correspondence: [email protected] † Equal contributors 5 Department of Surgical and Medical Sciences, Sapienza University, Ospedale S. Andrea, Rome, Italy Full list of author information is available at the end of the article
namely hypoechogenicity, irregular or blurred margins, microcalcifications, taller shape, and vascular signals [3,4]. In addition to conventional US, elastography is believed to improve the management of thyroid lesions, increasing the sensi
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