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Should Core Needle Biopsy be Used in the Evaluation of Thyroid Nodules?

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Abstract

Fine needle aspiration (FNA) is the first choice in thyroid nodules suspected of harboring malignancy on sonography in routine practice. However, sampling with core needle biopsy (CNB) is also being used, especially in cases with repeated nondiagnostic/indeterminate diagnoses. The aim of this study was the retrospective evaluation of CNB samples. A total of 604 thyroid CNB samples registered in the Department of Pathology at Bezmialem Foundation University Medical Faculty within the 1-year period between June 2014 and June 2015 were re-evaluated by correlation with previous FNA and later resection results. CNB was divided into diagnostic groups of insufficient, malignant, suspicious for malignancy, no evidence of malignancy/benign, atypia of uncertain significance (AUS)/follicular lesions of uncertain significance (FLUS), and follicular neoplasm (FN)/suspicious for follicular neoplasm (SFN). Among the 604 cases, 15 cases (2.48 %) were classified as malignant and 9 cases (1.49 %) as suspicious for malignancy. No evidence of malignancy was seen in 512 cases (84.76 %). There were 26 (4.3 %) cases in the AUS/FLUS-FN/SFN group, and the sample was inadequate in 42 cases (6.95 %). Resection was performed for 17 of the cases classified as malignant or suspicious for malignancy, and all were found to be malignant. There were also 10 resected cases with a diagnosis of no evidence of malignancy, and all were found to be benign. We think that sampling with CNB may be useful especially in repeating inadequate biopsies or cases diagnosed with AUS/FLUS that have hesitations regarding clinical management. Larger series including comparisons with FNA and resection results are required.

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References

  1. Haugen BR, Alexander EK, Bible KC, Doherty G, Mandel SJ, Nikiforov YE, Pacini F, Randolph G, Sawka A, Schlumberger M, SchuffKG,Sherman SI, Sosa JA, Steward D, Tuttle RM, Wartofsky L.2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2015 Oct 14.

  2. Edmund S. Cibas, Syed Z. Ali. The Bethesda System for Reporting Thyroid Cytopathology. Am J ClinPathol. 132:658–665, 2009.

    Google Scholar 

  3. Lee SH, Kim MH, Bae JS, Lim DJ, Jung SL, Jung CK. Clinical outcomes in patients with non-diagnostic thyroid fine needle aspiration cytology: usefulness of the thyroid core needle biopsy. AnnSurgOncol. 21(6):1870–7, 2014.

    Google Scholar 

  4. Orija IB, Piñeyro M, Biscotti C, Reddy SS, Hamrahian AH. Value of repeating a nondiagnostic thyroid fine-needle aspiration biopsy. EndocrPract. 13(7):735–42, 2007.

    Google Scholar 

  5. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 47003 patients with histologic and clinical correlations. Cancer. 25;111(5):306–15, 2007.

  6. Paja M, Del Cura JL, Zabala R, Corta I, Lizarraga A, Oleaga A, Expósito A, Gutiérrez MT, Ugalde A, López JI. Ultrasound-guided core-needle biopsy in thyroid nodules. A study of 676 consecutive cases with surgical correlation. Eur Radiol.2015 May 10.

  7. Yi KS, Kim JH, Na DG, Seo H, Min HS, Won JK, Yun TJ, Ryoo I, Kim SC, Choi SH, Sohn CH. Usefulness of core needle biopsy for thyroid nodules with macrocalcifications: comparison with fine-needle aspiration. Thyroid. 25(6):657–64, 2015.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Choi SH, Baek JH, Lee JH, Choi YJ, Hong MJ, Song DE, Kim JK, Yoon JH, Kim WB. Thyroid nodules with initially non-diagnostic, fine-needle aspiration results: comparison of core-needle biopsy and repeated fine-needle aspiration. EurRadiol. 24:2819–2826, 2014.

    Google Scholar 

  9. Samir AE, Vij A, Seale MK, Desai G, Halpern E, Faquin WC, Parangi S, Hahn PF, Daniels GH. Core needle biopsy is useful for diagnosis of thyroid nodules after previous FNA biopsy was nondiagnostic. Clinical Thyroidology 24(7):12–13, 2012.

    Google Scholar 

  10. Jung CK, Min HS, Park HJ, Song DE, Kim JH, Park SY, Yoo H, Shin MK; Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group. Pathology Reporting of Thyroid Core Needle Biopsy: A Proposal of the Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group. J PatholTransl Med. 49(4):288–99, 2015.

  11. Na DG, Kim JH, Sung JY, Baek JH, Jung KC, Lee H, YooH. Core-Needle Biopsy Is More Useful Than Repeat Fine-Needle Aspiration in Thyroid Nodules Read as Nondiagnostic or Atypia of Undetermined Significance by the Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 22(5):468–75, 2012.

  12. Trimboli P, Nasrollah N, Guidobaldi L, Taccogna S, CicciarellaModica DD, Amendola S, Romanelli F, Lenzi A, Nigri G1, Centanni M, Giovanella L, Valabrega S, Crescenzi A. 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. World J SurgOncol. 24;12:61, 2014.

  13. Khoo TK, Baker CH, Hallanger-Johnson J, Tom AM, Grant CS, Reading CC, Sebo TJ, Morris JC 3rd. Comparison of ultrasound-guided fine-needle aspiration biopsy with core-needle biopsy in the evaluation of thyroid nodules. EndocrPract. 14(4):426–3, 2008.

    Google Scholar 

  14. Nasrollah N, Trimboli P, Rossi F, Amendola S, Guidobaldi L, Ventura C, Maglio R, Nigri G, Romanelli F, Valabrega S, Crescenzi A. Patient’s comfort with and tolerability of thyroid core needle biopsy. Endocrine. 45(1):79–8, 2014.

    Article  CAS  PubMed  Google Scholar 

  15. Yoon JH, Kim EK, Kwak JY, Moon HJ. Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules: review of current literature. J PatholTransl Med. 49(3):230–5, 2015.

    Google Scholar 

  16. Trimboli P, Crescenzi A. Thyroid core needle biopsy: taking stock of the situation. Endocrine. 48(3):779–85, 2015.

    Article  CAS  PubMed  Google Scholar 

  17. Crescenzi A, Guidobaldi L, Nasrollah N, Taccogna S, CicciarellaModica DD, Turrini L, Nigri G, Romanelli F, Valabrega S, Giovanella L, Onetti Muda A, Trimboli P. Immunohistochemistry for BRAF (V600E) antibody VE1 performed in core needle biopsy samples identifies mutated papillary thyroid cancers. HormMetab Res. 46(5):370–4, 2014.

    CAS  Google Scholar 

  18. Yousaf U, Christensen LH, Rasmussen AK, Jensen F, Mollerup CL, Kirkegaard J, Lausen I, Rank F, Feldt-Rasmussen U. Immunohistochemical staining for thyroid peroxidase (TPO) of needle core biopsies in the diagnosis of scintigraphically cold thyroid nodules. ClinEndocrinol (Oxf). 68(6): 996–1001, 2008.

    Article  CAS  Google Scholar 

  19. Kwak JY1, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, Jung HK, Choi JS, Kim BM, Kim EK. Thyroid Imaging Reporting and Data System for US Features of Nodules : A Step in Establishing Better Stratification of Cancer Risk. Radiology. 260(3):892–9, 2011.

  20. Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, Vitti P; AACE/AME/ETATask Force on Thyroid Nodules. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. J Endocrinol Invest. 33(5 Suppl):1–50, 2010.

    CAS  PubMed  Google Scholar 

  21. Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, Moore FD Jr, Kim BW, Nosé V, Marqusee E, Larsen PR, Alexander EK. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 25;111(6):508–16, 2007 .

  22. Screaton NJ, Berman LH, Grant JW. US-guided core-needle biopsy of the thyroid gland. Radiology. 226(3):827–32, 2003 .

    Article  PubMed  Google Scholar 

  23. López JI, Zabala R, Del Cura JL. Histological Diagnosis of Thyroid Disease Using Ultrasound-Guided Core Biopsies. Eur Thyroid J. 2(1): 29–36, 2013.

  24. Renshaw AA, Pinnar N. Comparison of thyroid fine-needle aspiration and core needle biopsy. Am J ClinPathol. 128(3):370–4, 2007.

    Google Scholar 

  25. Hakala T, Kholová I, Sand J, Saaristo R, Kellokumpu-Lehtinen P. A core needle biopsy provides more malignancy-specific results than fine-needle aspiration biopsy in thyroid nodules suspicious for malignancy. J ClinPathol. 66(12):1046–50, 2013.

    CAS  Google Scholar 

  26. Strauss EB, Iovino A, Upender S.AJR Simultaneous fine-needle aspiration and core biopsy of thyroid nodules and other superficial head and neck masses using sonographic guidance Am J Roentgenol. 190(6):1697–9, 2008.

  27. Min HS, Kim JH, Ryoo I, Jung SL, Jung CK. The role of core needle biopsy in the preoperative diagnosis of follicular neoplasm of the thyroid. APMIS. 122(10):993–1000, 2014.

    Article  PubMed  Google Scholar 

  28. Sung JY, Na DG, Kim KS, Yoo H, Lee H, Kim JH, Baek JH. Diagnostic accuracy of fine-needle aspiration versus core-needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort. EurRadiol. 22(7):1564–72, 2012.

    Google Scholar 

  29. Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, Vitti P; AACE/AME/ETA Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. EndocrPract. 16(3):468–75, 2010.

    Google Scholar 

  30. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. American Thyroid Association (ATA) Guidelines Task force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 19(11):1167–214, 2009.

    Article  PubMed  Google Scholar 

  31. Ho AS, Sarti EE, Jain KS, Wang H, Nixon IJ, Shaha AR, Shah JP, Kraus DH, Ghossein R, Fish SA, Wong RJ, Lin O, Morris LG. Malignancy rate in thyroid nodules classified as Bethesda category III (AUS/FLUS). Thyroid. 24(5):832–9, 2014.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Yoon RG, Baek JH, Lee JH, Choi YJ, Hong MJ, Song DE, Kim JK, Yoon JH, Kim WB. Diagnosis of thyroid follicular neoplasm: fine-needle aspiration versus core-needle biopsy. Thyroid. 24(11):1612–7, 2014.

    Article  PubMed  Google Scholar 

  33. Park KT, Ahn SH, Mo JH, Park YJ, Park do J, Choi SI, Park SY. Role of core needle biopsy and ultrasono graphic finding in management of indeterminate thyroid nodules. HeadNeck. 33(2):160–5, 2011.

  34. Zhang S, Ivanovic M, Nemcek AA Jr, Defrias DV, Lucas E, Nayar R. Thin core needle biopsy crush preparations in conjunction with fine-needle aspiration for the evaluation of thyroid nodules: a complementary approach. Cancer. 25;114(6):512–8, 2008.

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Authors and Affiliations

  1. Department of Pathology, Bezmialem Foundation University Faculty of Medicine, İstanbul, Turkey

    Beril Guler, Tugce Kiran, Dilek Sema Arici & Fatma Cavide Sonmez

  2. Department of General Surgery, Bezmialem Foundation University Faculty of Medicine, İstanbul, Turkey

    Erhan Aysan

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  1. Beril Guler
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Correspondence to Beril Guler.

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Guler, B., Kiran, T., Arici, D.S. et al. Should Core Needle Biopsy be Used in the Evaluation of Thyroid Nodules?. Endocr Pathol 27, 352–358 (2016). https://doi.org/10.1007/s12022-016-9440-9

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