Core Needle Biopsy Specificity in Suspicious Thyroid Nodules
Core Needle Biopsy Specificity in Suspicious Thyroid Nodules
Background and aims The most commonly used diagnostic method for the preoperative diagnosis of thyroid nodules is ultrasound-guided fine-needle aspiration biopsy (FNA), which often yields non-diagnostic or non-definitive results and seldom produces definite malignant diagnoses. To improve upon the malignancy-specific sensitivity, we tested core needle biopsies (CNBs) of thyroid lesions taken from surgical specimens.
Material and methods 52 consecutive patients with malignant or malignant-suspicious thyroid nodules were referred to Tampere University Hospital between May 2010 and December 2011. Preoperative FNAs were categorised as follicular neoplasm (48%), suspicion for malignancy (46%) or malignancy (6%). Intraoperative FNA and CNB samples were acquired from surgical specimens removed during surgery. The results of the needle biopsies were compared with the final pathological diagnosis.
Results CNBs had a high definitive sensitivity for malignancy (61%, CI 41% to 78%) whereas the definitive sensitivity for malignancy of FNAs was significantly lower (22%, CI 10% to 42%). CNB was not beneficial in the diagnosis of follicular thyroid lesions. When all suspected follicular tumours were excluded, the definitive sensitivity of CNB rose to 70% (CI 48% to 86%).
Conclusions CNB may be beneficial for the diagnosis of papillary thyroid carcinoma and other non-follicular thyroid lesions. CNB may be considered as an additional diagnostic procedure in cases with FNA suspicious for malignancy.
The preoperative diagnosis of thyroid nodules can be challenging. The commonly used diagnostic procedure is ultrasound-guided fine-needle aspiration biopsy (FNA). Up to 35% of FNA samples have been shown to be non-diagnostic or have been classified as indeterminate or of unknown malignant potential. Several additional diagnostic procedures have been proposed, none of which has been established as a standard procedure. Several studies have been conducted on the usefulness of core needle biopsy (CNB) in the diagnostic workup of thyroid nodules. However, the results of these studies have been inconsistent, and no definitive recommendation has been established regarding the role of CNB in thyroid diagnostics.
The need for the surgical management of thyroid nodules is in a high degree determined by the preoperative FNA results, which are indeterminate in many cases regarding malignancy. If FNA is suspicious for malignancy, then operative treatment is required, but up to 79% of tumours prove to be benign. Enhanced preoperative diagnostic methods would decrease the number of unnecessary surgical procedures and thus decrease the risk of complications associated with surgery. These complications include infection and bleeding, permanent hypoparathyroidism and voice problems resulting from paralysis of the recurrent laryngeal nerve. Financial factors must also be considered, including the costs of sick leave and the operation. Last, but not least, patient quality of life is affected.
The use of CNB for thyroid nodule diagnosis has been studied in recent decades. No conclusive evidence exists for whether this method actually aids diagnosis. The method has not been demonstrated to be beneficial for any subgroup of patients; therefore, the main aim of this study was to identify subgroups of patients for which CNB might be beneficial.
Abstract and Introduction
Abstract
Background and aims The most commonly used diagnostic method for the preoperative diagnosis of thyroid nodules is ultrasound-guided fine-needle aspiration biopsy (FNA), which often yields non-diagnostic or non-definitive results and seldom produces definite malignant diagnoses. To improve upon the malignancy-specific sensitivity, we tested core needle biopsies (CNBs) of thyroid lesions taken from surgical specimens.
Material and methods 52 consecutive patients with malignant or malignant-suspicious thyroid nodules were referred to Tampere University Hospital between May 2010 and December 2011. Preoperative FNAs were categorised as follicular neoplasm (48%), suspicion for malignancy (46%) or malignancy (6%). Intraoperative FNA and CNB samples were acquired from surgical specimens removed during surgery. The results of the needle biopsies were compared with the final pathological diagnosis.
Results CNBs had a high definitive sensitivity for malignancy (61%, CI 41% to 78%) whereas the definitive sensitivity for malignancy of FNAs was significantly lower (22%, CI 10% to 42%). CNB was not beneficial in the diagnosis of follicular thyroid lesions. When all suspected follicular tumours were excluded, the definitive sensitivity of CNB rose to 70% (CI 48% to 86%).
Conclusions CNB may be beneficial for the diagnosis of papillary thyroid carcinoma and other non-follicular thyroid lesions. CNB may be considered as an additional diagnostic procedure in cases with FNA suspicious for malignancy.
Introduction
The preoperative diagnosis of thyroid nodules can be challenging. The commonly used diagnostic procedure is ultrasound-guided fine-needle aspiration biopsy (FNA). Up to 35% of FNA samples have been shown to be non-diagnostic or have been classified as indeterminate or of unknown malignant potential. Several additional diagnostic procedures have been proposed, none of which has been established as a standard procedure. Several studies have been conducted on the usefulness of core needle biopsy (CNB) in the diagnostic workup of thyroid nodules. However, the results of these studies have been inconsistent, and no definitive recommendation has been established regarding the role of CNB in thyroid diagnostics.
The need for the surgical management of thyroid nodules is in a high degree determined by the preoperative FNA results, which are indeterminate in many cases regarding malignancy. If FNA is suspicious for malignancy, then operative treatment is required, but up to 79% of tumours prove to be benign. Enhanced preoperative diagnostic methods would decrease the number of unnecessary surgical procedures and thus decrease the risk of complications associated with surgery. These complications include infection and bleeding, permanent hypoparathyroidism and voice problems resulting from paralysis of the recurrent laryngeal nerve. Financial factors must also be considered, including the costs of sick leave and the operation. Last, but not least, patient quality of life is affected.
The use of CNB for thyroid nodule diagnosis has been studied in recent decades. No conclusive evidence exists for whether this method actually aids diagnosis. The method has not been demonstrated to be beneficial for any subgroup of patients; therefore, the main aim of this study was to identify subgroups of patients for which CNB might be beneficial.
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