European Radiology

, Volume 28, Issue 9, pp 3848–3860 | Cite as

Complications following ultrasound-guided core needle biopsy of thyroid nodules: a systematic review and meta-analysis

  • Eun Ju Ha
  • Chong Hyun Suh
  • Jung Hwan BaekEmail author
Head and Neck



To identify the complication rate associated with US-guided core needle biopsy (CNB) of thyroid lesions using a systematic review and meta-analysis.


Ovid-MEDLINE and EMBASE databases were searched for studies on US-guided CNB of thyroid lesions from 1 January 1994–13 December 2016. A review of 393 potential papers identified 39 eligible papers including 14,818 patients. The pooled proportions of complications were assessed using random-effects modelling. Subgroup analysis was performed. Among-study heterogeneity was explored using χ2 statistic for pooled estimates and inconsistency index I2. Quality of the studies was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies.


The pooled proportion of overall complications after CNB of thyroid lesions was 1.11% (95% CI: 0.64–1.51, I2: 87.2%). The pooled proportion of major complications (0.06% [95% CI: 0.02–0.10], I2: 0.0%) was much lower than that of minor complications (1.08%[95% CI: 0.63–1.53], I2: 93.17%). Subgroup analysis revealed no significant differences between studies on Asian versus non-Asian groups (p=0.7769), radiologist versus non-radiologist groups (p=0.8607), nodule size <20 mm versus nodule size ≥20 mm (p=0.1591) groups, CNB versus CNB-plus-FNA groups (p=0.9281) and studies performed before and after 2012 (p=0.6251). The overall quality of the included studies was moderate with all of the studies satisfying five or more of the eight total domains.


Various complications can occur after US-guided CNB of thyroid lesions. However, the procedure is safe, with a low complication rate.

Key Points

• Various complications occurred after CNB of thyroid lesions, but the pooled complication rate was low (1.11%, I 2 = 87.2%).

• The pooled proportion of major complications (0.06%) was much lower than that of minor complications (1.08%).

• There was no significant differences between studies on Asian vs. non-Asian groups, radiologist vs. non-radiologist groups, nodule size <20 mm vs. nodule size ≥20 mm groups, CNB vs. CNB-plus-FNA groups, or studies performed before 2012 vs. after 2012.


Core needle biopsy Meta-analysis Safety Thyroid nodule Ultrasonography 



Confidence interval


Core needle biopsy


Fine-needle aspiration





The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Jung Hwan Baek.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Chong Hyun Suh performed statistical analysis for this paper.

Informed consent

Written informed consent was not required for this study because this study was designed as a systematic review with meta-analysis.

Ethical approval

Institutional Review Board approval was not required because this study was designed as a systematic review with meta-analysis.


• systematic review with meta-analysis


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyAjou University School of MedicineSuwonKorea
  2. 2.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulRepublic of Korea
  3. 3.Department of RadiologyNamwon Medical CenterNamwon-siRepublic of Korea

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