European Radiology

, Volume 24, Issue 6, pp 1403–1409 | Cite as

Core needle biopsy can minimise the non-diagnostic results and need for diagnostic surgery in patients with calcified thyroid nodules

  • Eun Ju Ha
  • Jung Hwan Baek
  • Jeong Hyun Lee
  • Jin Kyoung Kim
  • Jae Kyun Kim
  • Hyun Kyung Lim
  • Dong Eun Song
  • Tae Yon Sung
  • Tae Yong Kim
  • Won Bae Kim
  • Young Kee Shong
Head and Neck

Abstract

Purpose

To evaluate the role of core needle biopsy (CNB) for calcified thyroid nodules.

Methods

Between October 2008 and July 2011, 264 patients underwent ultrasound-guided CNB for 272 calcified thyroid nodules at our institution. We retrospectively evaluated the incidence of technical failure, non-diagnostic readings, and the diagnostic performance of CNB, and analysed the relationship between the types of calcification and the CNB results. Finally, the incidence of diagnostic surgery was calculated.

Results

The incidence of technical failure was 1.1 % (3/275) and that of non-diagnostic results was 0.7 % (2/272). The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CNB were 94.7 %, 89.5 %, 100 %, 100 %, and 90.2 %, respectively. There were no significant differences according to the calcification subtype for either the non-diagnostic results or the incidence of technical failure (P > 0.99 and P > 0.99). CNB could prevent diagnostic surgery for 92.9 % (13/14) of the patients who showed more than two non-diagnostic results in previous FNA.

Conclusions

CNB can minimise the non-diagnostic results as well as diagnostic surgery in patients with calcified thyroid nodules. Therefore, CNB may be used as a first-line diagnostic tool for calcified thyroid nodules rather than FNA.

Key points

CNB results show the low incidence of technical failure (1.1 %, 3/275).

CNB results show the low non-diagnostic rate (0.7 %, 2/272).

There were no significant differences according to the calcification subtype.

CNB can prevent unnecessary diagnostic surgery in 92.9 % (13/14).

Keywords

Core needle biopsy Calcification Non-diagnostic results Fine-needle aspiration 

Abbreviations

US

ultrasound

FNA

fine-needle aspiration

CNB

core-needle biopsy

References

  1. 1.
    Baloch ZW, Cibas ES, Clark DP et al (2008) The National Cancer Institute Thyroid fine needle aspiration state of the science conference: a summation. Cytojournal 5:6PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Choi SH, Han KH, Yoon JH et al (2011) Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf) 74:776–782CrossRefGoogle Scholar
  3. 3.
    Choi YS, Hong SW, Kwak JY, Moon HJ, Kim EK (2012) Clinical and ultrasonographic findings affecting nondiagnostic results upon the second fine needle aspiration for thyroid nodules. Ann Surg Oncol 19:2304–2309PubMedCrossRefGoogle Scholar
  4. 4.
    Cibas ES, Ali SZ (2009) The Bethesda System for Reporting Thyroid Cytopathology. Thyroid 19:1159–1165PubMedCrossRefGoogle Scholar
  5. 5.
    Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214PubMedCrossRefGoogle Scholar
  6. 6.
    Gharib H, Papini E, Paschke R et al (2010) American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and EuropeanThyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract 16:1–43PubMedCrossRefGoogle Scholar
  7. 7.
    Ha EJ, Baek JH, Lee JH et al (2013) Sonographically suspicious thyroid nodules with initially benign cytologic results: the role of a core needle biopsy. Thyroid 23:703–708PubMedCrossRefGoogle Scholar
  8. 8.
    Hryhorczuk AL, Stephens T, Bude RO et al (2012) Prevalence of malignancy in thyroid nodules with an initial nondiagnostic result after ultrasound guided fine needle aspiration. Ultrasound Med Biol 38:561–567PubMedCrossRefGoogle Scholar
  9. 9.
    Jo VY, Vanderlaan PA, Marqusee E, Krane JF (2011) Repeatedly nondiagnostic thyroid fine-needle aspirations do not modify malignancy risk. Acta Cytol 55:539–543PubMedCrossRefGoogle Scholar
  10. 10.
    Khoo ML, Asa SL, Witterick IJ, Freeman JL (2002) Thyroid calcification and its association with thyroid carcinoma. Head Neck 24:651–655PubMedCrossRefGoogle Scholar
  11. 11.
    Kwak JY, Jung I, Baek JH et al (2013) Image reporting and characterization system for ultrasound features of thyroid nodules: multicentric korean retrospective study. Korean J Radiol 14:110–117PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Kwak JY, Kim EK, Kim MJ, Son EJ (2009) Significance of sonographic characterization for managing subcentimeter thyroid nodules. Acta Radiol 50:917–923PubMedCrossRefGoogle Scholar
  13. 13.
    Lee J, Lee SY, Cha SH, Cho BS, Kang MH, Lee OJ (2013) Fine needle aspiration of thyroid nodules with macrocalcification. Thyroid 23:1106–1112PubMedCrossRefGoogle Scholar
  14. 14.
    Lubitz CC, Nagarkatti SS, Faquin WC et al (2012) Diagnostic yield of nondiagnostic thyroid nodules is not altered by timing of repeat biopsy. Thyroid 22:590–594PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Moon WJ, Baek JH, Jung SL et al (2011) Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol 12:1–14PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Moon WJ, Jung SL, Lee JH et al (2008) Benign and malignant thyroid nodules: US differentiation–multicenter retrospective study. Radiology 247:762–770PubMedCrossRefGoogle Scholar
  17. 17.
    Na DG, Kim JH, Sung JY et al (2012) 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 22:468–475PubMedCrossRefGoogle Scholar
  18. 18.
    Na DG, Lee JH, Jung SL et al (2012) Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations. Korean J Radiol 13:117–125PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Nasrollah N, Trimboli P, Guidobaldi L et al (2013) Thin core biopsy should help to discriminate thyroid nodules cytologically classified as indeterminate. A new sampling technique. Endocrine 43:659–665PubMedCrossRefGoogle Scholar
  20. 20.
    Nasrollah N, Trimboli P, Rossi F, et al. (2013) Patient's comfort with and tolerability of thyroid core needle biopsy. EndocrineGoogle Scholar
  21. 21.
    Orija IB, Pineyro M, Biscotti C, Reddy SS, Hamrahian AH (2008) Value of repeating a nondiagnostic thyroid fine-needle aspiration biopsy. Endocr Pract 13:735–742CrossRefGoogle Scholar
  22. 22.
    Park KT, Ahn SH, Mo JH et al (2011) Role of core needle biopsy and ultrasonographic finding in management of indeterminate thyroid nodules. Head Neck 33:160–165PubMedCrossRefGoogle Scholar
  23. 23.
    Samir AE, Vij A, Seale MK et al (2012) Ultrasound-guided percutaneous thyroid nodule core biopsy: clinical utility in patients with prior nondiagnostic fine-needle aspirate. Thyroid 22:461–467PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Screaton NJ, Berman LH, Grant JW (2003) US-guided core-needle biopsy of the thyroid gland. Radiology 226:827–832PubMedCrossRefGoogle Scholar
  25. 25.
    Sung JY, Na DG, Kim KS et al (2012) Diagnostic accuracy of fine-needle aspiration versus core-needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort. Eur Radiol 22:1564–1572PubMedCrossRefGoogle Scholar
  26. 26.
    Yeon JS, Baek JH, Lim HK et al (2013) Thyroid nodules with initially nondiagnostic cytologic results: the role of core-needle biopsy. Radiology 268:274–280PubMedCrossRefGoogle Scholar
  27. 27.
    Yoo EY, Shin JH, Ko EY, Han BK (2012) Contribution of the BRAF mutation analysis in calcified thyroid nodules. AJR Am J Roentgenol 198:891–895PubMedCrossRefGoogle Scholar
  28. 28.
    Yoon DY, Lee JW, Chang SK et al (2007) Peripheral calcification in thyroid nodules: ultrasonographic features and prediction of malignancy. J Ultrasound Med 26:1349–1355, quiz 1356–1347PubMedGoogle Scholar
  29. 29.
    Yunker WK, Hassan SF, Ferrell LB et al (2013) Needle core biopsy in the diagnosis of pediatric thyroid neoplasms: a single institution retrospective review. Pediatr Surg Int 29:437–443PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Eun Ju Ha
    • 1
    • 2
  • Jung Hwan Baek
    • 1
  • Jeong Hyun Lee
    • 1
  • Jin Kyoung Kim
    • 1
  • Jae Kyun Kim
    • 3
  • Hyun Kyung Lim
    • 1
    • 4
  • Dong Eun Song
    • 5
  • Tae Yon Sung
    • 6
  • Tae Yong Kim
    • 7
  • Won Bae Kim
    • 7
  • Young Kee Shong
    • 7
  1. 1.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSongpa-GuKorea
  2. 2.Department of RadiologyAjou University School of MedicineYeongtong-GuKorea
  3. 3.Department of RadiologyChung-Ang University College of MedicineDongjak-guKorea
  4. 4.Department of RadiologySoonchunhyang University HospitalYongsan-GuKorea
  5. 5.Department of PathologyUniversity of Ulsan College of Medicine, Asan Medical CenterSongpa-GuKorea
  6. 6.Department of SurgeryUniversity of Ulsan College of Medicine, Asan Medical CenterSongpa-GuRepublic of Korea
  7. 7.Department of Endocrinology and MetabolismUniversity of Ulsan College of Medicine, Asan Medical CenterSongpa-GuRepublic of Korea

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