, Volume 48, Issue 3, pp 779–785 | Cite as

Thyroid core needle biopsy: taking stock of the situation

Endocrine Methods and Techniques


Recently, the microhistologic evaluation by core needle biopsy (CNB) has been reported as high accurate to diagnose thyroid nodules with previous indeterminate or not adequate fine-needle aspiration cytology. In addition, sparse data have been reported regarding the use of CNB in other conditions. Aim of this review was to furnish the state of the art of this topic by summarizing published data about the diagnostic performance of CNB in thyroid lesions, and provide an easy to use reference for clinical practice. Sources encompass studies published through May 2014. Original articles were investigated and following specific aspects were discussed: 1. The “large” needle biopsy in 90’s; 2. Complications by and patient’s comfort with thyroid CNB; 3. Advantages provided by examination of a microhistologic sample of thyroid nodule; 4. Use of CNB in thyroid nodules with previous not adequate (Thy 1/Class 1/Category I) cytology; 5. Use of CNB in thyroid neoplasms (Thy 3/Class 3/Category III–IV) cytology; 6. Use of CNB in specific ultrasonographic presentations of thyroid nodules or in patients with peculiar clinical contexts; 7. First-line approach by CNB in thyroid nodules; 8. Immunohistochemistry and molecular tests on CNB samples; and 9. Future perspective.


Thyroid cancer Thyroid nodules Core needle biopsy (CNB) 


  1. 1.
    H. Gharib, E. Papini, R. Paschke, D.S. Duick, R. Valcavi, L. Hegedüs, P. Vitti, 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. Endocr. Pract. 16, 1–43 (2010)CrossRefPubMedGoogle Scholar
  2. 2.
    Royal College of Physicians of London, Guidelines for the Management of Thyroid Cancer, 2nd edn. (The Lavenham Press, Suffolk, 2007)Google Scholar
  3. 3.
    E.S. Cibas, S.Z. Ali, The Bethesda system for reporting thyroid cytopathology. Thyroid 19, 1159–1165 (2009)CrossRefPubMedGoogle Scholar
  4. 4.
    American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, D.S. Cooper, G.M. Doherty, B.R. Haugen, R.T. Kloos, S.L. Lee, S.J. Mandel, E.L. Mazzaferri, B. McIver, F. Pacini, M. Schlumberger, S.I. Sherman, D.L. Steward, R.M. Tuttle, Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19, 1167–1214 (2009)CrossRefGoogle Scholar
  5. 5.
    N.J. Screaton, L.H. Berman, J.W. Grant, US-guided core-needle biopsy of the thyroid gland. Radiology 226, 827–832 (2003)CrossRefPubMedGoogle Scholar
  6. 6.
    T.K. Khoo, C.H. Baker, J. Hallanger-Johnson, A.M. Tom, C.S. Grant, C.C. Reading, T.J. Sebo, J.C. Morris 3rd, Comparison of ultrasound-guided fine-needle aspiration biopsy with core-needle biopsy in the evaluation of thyroid nodules. Endocr. Pract. 14, 426–431 (2008)CrossRefPubMedGoogle Scholar
  7. 7.
    E.B. Strauss, A. Iovino, S. Upender, Simultaneous fine-needle aspiration and core biopsy of thyroid nodules and other superficial head and neck masses using sonographic guidance. Am. J. Roentgenol. 190, 1697–2709 (2008)CrossRefGoogle Scholar
  8. 8.
    D. Lieu, Cytopathologist-performed ultrasound-guided fine-needle aspiration and core-needle biopsy: a prospective study of 500 consecutive cases. Diagn. Cytopathol. 36, 317–324 (2008)CrossRefPubMedGoogle Scholar
  9. 9.
    A.A. Renshaw, N. Pinnar, Comparison of thyroid fine-needle aspiration and core needle biopsy. Am. J. Clin. Pathol. 128, 370–374 (2007)CrossRefPubMedGoogle Scholar
  10. 10.
    J.Y. Sung, D.G. Na, K.S. Kim, H. Yoo, H. Lee, J.H. Kim, J.H. Baek, Diagnostic accuracy of fine-needle aspiration versus core-needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort. Eur. Radiol. 22, 1564–1572 (2012)CrossRefPubMedGoogle Scholar
  11. 11.
    J.M. Miller, J.I. Hamburger, S. Kini, Diagnosis of thyroid nodules. Use of fine-needle aspiration and needle biopsy. JAMA 241, 481–484 (1979)CrossRefPubMedGoogle Scholar
  12. 12.
    A.E. Samir, A. Vij, M.K. Seale, E. Halpern, W.C. Faquin, S. Parangi, P.F. Hahn, G.H. Daniels, Ultrasound-guided percutaneous thyroid nodule core biopsy: clinical utility in patients with prior nondiagnostic fine-needle aspirate. Thyroid 22, 461–467 (2012)CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    S. Zhang, M. Ivanovic, A.A. Nemcek Jr, D.V. Defrias, E. Lucas, R. Nayar, Thin core needle biopsy crush preparations in conjunction with fine-needle aspiration for the evaluation of thyroid nodules: a complementary approach. Cancer 114, 512–518 (2008)CrossRefPubMedGoogle Scholar
  14. 14.
    S.H. Lee, M.H. Kim, J.S. Bae, D.J. Lim, S.L. Jung, C.K. Jung, Clinical outcomes in patients with non-diagnostic thyroid fine needle aspiration cytology: usefulness of the thyroid core needle biopsy. Ann. Surg. Oncol. 21, 1870–1877 (2014)CrossRefPubMedGoogle Scholar
  15. 15.
    J.S. Yeon, J.H. Baek, H.K. Lim, E.J. Ha, J.K. Kim, D.E. Song, T.Y. Kim, J.H. Lee, Thyroid nodules with initially nondiagnostic cytologic results: the role of core-needle biopsy. Radiology 268, 274–280 (2013)CrossRefPubMedGoogle Scholar
  16. 16.
    D.G. Na, J.H. Kim, J.Y. Sung, J.H. Baek, K.C. Jung, H. Lee, H. Yoo, 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, 468–475 (2012)CrossRefPubMedGoogle Scholar
  17. 17.
    Y.J. Choi, J.H. Baek, E.J. Ha, H.K. Lim, J.H. Lee, J.K. Kim, D.E. Song, Y.K. Shong, S.J. Hong, Differences in risk of malignancy and management recommendations in subcategories of thyroid nodules with atypia of undetermined significance or follicular lesion of undetermined significance: the role of ultrasound-guided core-needle biopsy. Thyroid 24, 494–501 (2014)CrossRefPubMedGoogle Scholar
  18. 18.
    T. Hakala, I. Kholová, J. Sand, R. Saaristo, P. Kellokumpu-Lehtinen, A core needle biopsy provides more malignancy-specific results than fine-needle aspiration biopsy in thyroid nodules suspicious for malignancy. J. Clin. Pathol. 66, 1046–1050 (2013)CrossRefPubMedGoogle Scholar
  19. 19.
    S.Y. Hahn, J.H. Shin, B.K. Han, E.Y. Ko, E.S. Ko, Ultrasonography-guided core needle biopsy for the thyroid nodule: does the procedure hold any benefit for the diagnosis when fine-needle aspiration cytology analysis shows inconclusive results? Br. J. Radiol. 86, 20130007 (2013)CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    K.T. Park, S.H. Ahn, J.H. Mo, Y.J. Park, J. Park, S.I. Choi, S.Y. Park, Role of core needle biopsy and ultrasonographic finding in management of indeterminate thyroid nodules. Head Neck 33, 160–165 (2011)CrossRefPubMedGoogle Scholar
  21. 21.
    N. Nasrollah, P. Trimboli, L. Guidobaldi, D.D. Cicciarella Modica, C. Ventura, G. Ramacciato, S. Taccogna, F. Romanelli, S. Valabrega, A. Crescenzi, Thin core biopsy should help to discriminate thyroid nodules cytologically classified as indeterminate. A new sampling technique. Endocrine 43, 659–665 (2013)CrossRefPubMedGoogle Scholar
  22. 22.
    H.S. Min, J.H. Kim, I. Ryoo, S.L. Jung, C.K. Jung, The role of core needle biopsy in the preoperative diagnosis of follicular neoplasm of the thyroid. APMIS (2014). doi:10.1111/apm.12244 Google Scholar
  23. 23.
    E.J. Ha, J.H. Baek, J.H. Lee, D.E. Song, J.K. Kim, Y.K. Shong, S.J. Hong, Sonographically suspicious thyroid nodules with initially benign cytologic results: the role of a core needle biopsy. Thyroid 23, 703–708 (2013)CrossRefPubMedGoogle Scholar
  24. 24.
    P. Trimboli, N. Nasrollah, L. Guidobaldi, S. Taccogna, D.D. Cicciarella Modica, S. Amendola, F. Romanelli, A. Lenzi, G. Nigri, M. Centanni, L. Giovanella, S. Valabrega, A. Crescenzi, 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. Surg. Oncol. 12, 61 (2014)CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    E.J. Ha, J.H. Baek, J.H. Lee, J.K. Kim, J.K. Kim, H.K. Lim, D.E. Song, T.Y. Sung, T.Y. Kim, W.B. Kim, Y.K. Shong, Core needle biopsy can minimise the non-diagnostic results and need for diagnostic surgery in patients with calcified thyroid nodules. Eur. Radiol. 24, 1403–1409 (2014)CrossRefPubMedGoogle Scholar
  26. 26.
    M. Zhang, Y. Zhang, S. Fu, F. Lv, J. Tang, Thyroid nodules with suspicious ultrasound findings: the role of ultrasound-guided core needle biopsy. Clin. Imaging 38, 434–438 (2014)CrossRefPubMedGoogle Scholar
  27. 27.
    W.K. Yunker, S.F. Hassan, L.B. Ferrell, M.J. Hicks, C.M. Giannoni, D.E. Wesson, C.I. Cassady, J.A. Hernandez, M.L. Brandt, M.E. Lopez, Needle core biopsy in the diagnosis of pediatric thyroid neoplasms: a single institution retrospective review. Pediatr. Surg. Int. 29, 437–443 (2013)CrossRefPubMedGoogle Scholar
  28. 28.
    K. Buxey, J. Serpell, Importance of core biopsy in the diagnosis of thyroid lymphoma. ANZ J. Surg. 82, 90–91 (2012)CrossRefPubMedGoogle Scholar
  29. 29.
    M. Nam, J.H. Shin, B.K. Han, E.Y. Ko, E.S. Ko, S.Y. Hahn, J.H. Chung, Y.L. Oh, Thyroid lymphoma: correlation of radiologic and pathologic features. J. Ultrasound Med. 31, 589–594 (2012)PubMedGoogle Scholar
  30. 30.
    A. Crescenzi, L. Guidobaldi, N. Nasrollah, S. Taccogna, D.D. Cicciarella Modica, L. Turrini, G. Nigri, F. Romanelli, S. Valabrega, L. Giovanella, A. Onetti Muda, P. Trimboli, Immunohistochemistry for BRAF(V600E) antibody VE1 performed in core needle biopsy samples identifies mutated papillary thyroid cancers. Horm. Metab. Res. 46, 370–374 (2014)CrossRefPubMedGoogle Scholar
  31. 31.
    A. Carpi, A.G. Naccarato, G. Iervasi, A. Nicolini, G. Bevilacqua, P. Viacava, P. Collecchi, L. Lavra, C. Marchetti, S. Sciacchitano, A. Bartolazzi, Large needle aspiration biopsy and galectin-3 determination in selected thyroid nodules with indeterminate FNA-cytology. Br. J. Cancer 95, 204–209 (2006)CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    U. Yousaf, L.H. Christensen, A.K. Rasmussen, F. Jensen, C.L. Mollerup, J. Kirkegaard, I. Lausen, F. Rank, U. Feldt-Rasmussen, Immunohistochemical staining for thyroid peroxidase (TPO) of needle core biopsies in the diagnosis of scintigraphically cold thyroid nodules. Clin. Endocrinol. (Oxf.) 68, 996–1001 (2008)CrossRefGoogle Scholar
  33. 33.
    N. Nasrollah, P. Trimboli, F. Rossi, S. Amendola, L. Guidobaldi, C. Ventura, R. Maglio, G. Nigri, F. Romanelli, S. Valabrega, A. Crescenzi, Patient’s comfort with and tolerability of thyroid core needle biopsy. Endocrine 45, 79–83 (2014)CrossRefPubMedGoogle Scholar
  34. 34.
    A. Carpi, G. Rossi, A. Nicolini, G. Iervasi, M. Russo, J. Mechanick, Does large needle aspiration biopsy add pain to the thyroid nodule evaluation? PLoS One 8, e58016 (2013)CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    A. Stangierski, K. Wolinski, K. Martin, O. Leitgeber, M. Ruchala, Core needle biopsy of thyroid nodules: evaluation of diagnostic utility and pain experience. Neuro. Endocrinol. Lett. 34, 798–801 (2013)PubMedGoogle Scholar
  36. 36.
    Q. Liu, M. Castelli, P. Gattuso, R.A. Prinz, Simultaneous fine-needle aspiration and core-needle biopsy of thyroid nodules. Am. Surg. 61, 628–633 (1995)PubMedGoogle Scholar
  37. 37.
    A. Carpi, A. Sagripanti, A. Nicolini, S. Santini, E. Ferrari, R. Romani, G. Di Coscio, Large needle aspiration biopsy for reducing the rate of inadequate cytology on fine needle aspiration specimens from palpable thyroid nodules. Biomed. Pharmacother. 52, 303–307 (1998)CrossRefPubMedGoogle Scholar
  38. 38.
    F. Nardi, F. Basolo, A. Crescenzi, G. Fadda, A. Frasoldati, F. Orlandi, L. Palombini, E. Papini, M. Zini, A. Pontecorvi, P. Vitti, Italian consensus for the classification and reporting of thyroid cytology. J. Endocrinol. Invest. 37, 593–599 (2014)CrossRefPubMedGoogle Scholar
  39. 39.
    Z.W. Baloch, M.J. Sack, G.H. Yu, V.A. Livolsi, P.K. Gupta, Fine-needle aspiration of thyroid: an institutional experience. Thyroid 8, 565–569 (1998)CrossRefPubMedGoogle Scholar
  40. 40.
    R. Mihai, A.J. Parker, D. Roskell, G.P. Sadler, One in four patients with follicular thyroid cytology (THY3) has a thyroid carcinoma. Thyroid 19, 33–37 (2009)CrossRefPubMedGoogle Scholar
  41. 41.
    P. Trimboli, G. Treglia, L. Guidobaldi, E. Saggiorato, G. Nigri, A. Crescenzi, F. Romanelli, F. Orlandi, S. Valabrega, R. Sadeghi, L. Giovanella, Clinical characteristics as predictors of malignancy in patients with indeterminate thyroid cytology: a meta-analysis. Endocrine 46, 52–59 (2014)CrossRefPubMedGoogle Scholar
  42. 42.
    A. Bartolazzi, F. Orlandi, E. Saggiorato, M. Volante, F. Arecco, R. Rossetto, N. Palestini, E. Ghigo, M. Papotti, G. Bussolati, M.P. Martegani, F. Pantellini, A. Carpi, M.R. Giovagnoli, S. Monti, V. Toscano, S. Sciacchitano, G.M. Pennelli, C. Mian, M.R. Pelizzo, M. Rugge, G. Troncone, L. Palombini, G. Chiappetta, G. Botti, A. Vecchione, R. Bellocco, Italian Thyroid Cancer Study Group (ITCSG): Galectin-3-expression analysis in the surgical selection of follicular thyroid nodules with indeterminate fine-needle aspiration cytology: a prospective multicentre study. Lancet Oncol. 9, 543–549 (2008)CrossRefPubMedGoogle Scholar
  43. 43.
    P. Trimboli, E. Condorelli, A. Catania, S. Sorrenti, Clinical and ultrasound parameters in the approach to thyroid nodules cytologically classified as indeterminate neoplasm. Diagn. Cytopathol. 37, 783–785 (2009)CrossRefPubMedGoogle Scholar
  44. 44.
    T. Rago, G. Di Coscio, F. Basolo, M. Scutari, R. Elisei, P. Berti, P. Miccoli, R. Romani, P. Faviana, A. Pinchera, P. Vitti, Combined clinical, thyroid ultrasound and cytological features help to predict thyroid malignancy in follicular and Hürthle cell thyroid lesions: results from a series of 505 consecutive patients. Clin. Endocrinol. (Oxf). 66, 13–20 (2007)Google Scholar
  45. 45.
    A. Heinzel, D. Müller, F.F. Behrendt, L. Giovanella, F.M. Mottaghy, F.A. Verburg, Thyroid nodules with indeterminate cytology: molecular imaging with 99mTc-methoxyisobutylisonitrile (MIBI) is more cost-effective than the Afirma® gene expression classifier. Eur. J. Nucl. Med. Mol. Imaging (2014). doi:10.1007/s00259-014-2760-4 Google Scholar
  46. 46.
    J.Y. Kwak, E.K. Kim, H.J. Kim, M.J. Kim, E.J. Son, H.J. Moon, How to combine ultrasound and cytological information in decision making about thyroid nodules. Eur. Radiol. 19, 1923–1931 (2009)CrossRefPubMedGoogle Scholar
  47. 47.
    F.F. Maia, P.S. Matos, E.J. Pavin, J. Vassallo, D.E. Zantut-Wittmann, Value of repeat ultrasound-guided fine-needle aspiration in thyroid nodule with a first benign cytologic result: impact of ultrasound to predict malignancy. Endocrine 40, 290–296 (2011)CrossRefPubMedGoogle Scholar
  48. 48.
    Y.J. Choi, I. Jung, S.J. Min, H.J. Kim, J.H. Kim, S. Kim, J.S. Park, J.H. Shin, Y.M. Sohn, J.H. Yoon, J.Y. Kwak, Thyroid nodule with benign cytology: is clinical follow-up enough? PLoS One 8, e63834 (2013)CrossRefPubMedCentralPubMedGoogle Scholar
  49. 49.
    C.A. Dinauer, C. Breuer, S.A. Rivkees, Differentiated thyroid cancer in children: diagnosis and management. Curr. Opin. Oncol. 20, 59–65 (2008)CrossRefPubMedGoogle Scholar
  50. 50.
    A.K. Zimmermann, U. Camenisch, M.P. Rechsteiner, B. Bode-Lesniewska, M. Rössle, Value of immunohistochemistry in the detection of BRAF(V600E) mutations in fine-needle aspiration biopsies of papillary thyroid carcinoma. Cancer Cytopathol. 122, 48–58 (2014)CrossRefPubMedGoogle Scholar
  51. 51.
    E.D. Rossi, M. Martini, S. Capodimonti, T. Cenci, P. Straccia, B. Angrisani, C. Ricci, P. Lanza, C.P. Lombardi, A. Pontecorvi, L.M. Larocca, G. Fadda, Analysis of immunocytochemical and molecular BRAF expression in thyroid carcinomas: a cytohistologic institutional experience. Cancer Cytopathol. (2014). doi:10.1002/cncy.21416 Google Scholar
  52. 52.
    D. Capper, M. Preusser, A. Habel, F. Sahm, U. Ackermann, G. Schindler, S. Pusch, G. Mechtersheimer, H. Zentgraf, A. von Deimling, Assessment of BRAF V600E mutation status by immunohistochemistry with a mutation-specific monoclonal antibody. Acta Neuropathol. 122, 11–19 (2011)CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Section of Endocrinology and DiabetologyOspedale IsraeliticoRomeItaly
  2. 2.Pathology UnitCampus Biomedico University HospitalRomeItaly

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