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Ultrasound-guided core-needle biopsy in thyroid nodules. A study of 676 consecutive cases with surgical correlation

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Abstract

Objectives

To analyze the diagnostic accuracy of ultrasound-guided core-needle biopsy (CNB) of thyroid nodules.

Methods

Of 3517 CNBs performed using an 18G spring-loaded device in one institution, we retrospectively reviewed 676 nodules in 629 consecutive patients who underwent surgery. CNB and pathological examination were compared. CNB diagnosis was standardized in four categories: insufficient (I), benign (B), follicular lesion (FOL), and malignant (M). Main outcome measures were predictive positive values (PPV), false positives (FP), and false negatives (FN).

Results

CNB showed a low rate of insufficient and FOL diagnoses (5.8 % and 4.5 %). On surgery, there were eight FNs in 374 benign CNBs and three FPs in 148 malignant CNBs. The 154 nodules classified as FOL in CNB included, at surgery, 122 neoplasms; 28 of them malignant. PPV for malignancy of a malignant CNB was 98 %, and for a CNB diagnosis of FOL 18.2 %. Sensitivity for malignancy if CNB of FOL and M are considered positive was 95.6. Only one major complication was observed.

Conclusions

CNB is reliable, safe, and accurate to evaluate thyroid nodules and can be an alternative technique to FNA. It has low rate of non-diagnostic and undetermined cases, with high sensitivity and PPV.

Key Points

• Thyroid core-needle biopsy (CNB) has high sensitivity and PPV.

• Pitfalls of CNB are rare.

• Pitfalls are due to cystic cancer, histological heterogeneity, and mistakes in analysis.

• CNB is a reliable, safe, and accurate method to approach thyroid nodules.

• CNB can be used primarily or after insufficient or indeterminate FNA.

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Acknowledgments

The scientific guarantor of this publication is Jose Luis del Cura. Jose Luis del Cura declares relationships as advisor of CIVCO. The remaining authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Jose Luis del Cura provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study.

Methodology: retrospective, diagnostic study / observational, performed at one institution.

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Authors and Affiliations

  1. Department of Endocrinology, Basurto University Hospital, Bilbao, Spain

    Miguel Paja, Aitzol Lizarraga & Amelia Oleaga

  2. Department of Radiology, Basurto University Hospital, Bilbao, Spain

    Jose L. del Cura, Rosa Zabala & Igone Corta

  3. Department of Endocrine Surgery, Basurto University Hospital, Bilbao, Spain

    Amaia Expósito & M. Teresa Gutiérrez

  4. Department of Pathology, Basurto University Hospital, Bilbao, Spain

    Aitziber Ugalde

  5. Department of Pathology, Cruces University Hospital, Barakaldo, Spain

    José I. López

  6. Basque Country University, Bilbao, Spain

    Miguel Paja, Jose L. del Cura & José I. López

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  1. Miguel Paja
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Correspondence to Jose L. del Cura.

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Paja, M., del Cura, J.L., Zabala, R. et al. Ultrasound-guided core-needle biopsy in thyroid nodules. A study of 676 consecutive cases with surgical correlation. Eur Radiol 26, 1–8 (2016). https://doi.org/10.1007/s00330-015-3821-1

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  • DOI: https://doi.org/10.1007/s00330-015-3821-1

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