Ultrasound-guided Core Needle Biopsy for Thyroid Nodules Improves Diagnostic Yield - Nederlandse Vereniging voor Endocrinologie

Ultrasound-guided Core Needle Biopsy for Thyroid Nodules Improves Diagnostic Yield

Anneline van den Ende⁽¹⁾, Herman Zandvoort⁽¹⁾, Riena Aliredjo⁽²⁾, Peter Veendrick⁽²⁾, Ernst Bom ⁽¹⁾, Frank Joosten⁽¹⁾,

and Hans de Boer (3)

Departments of Radiology (1), Pathology (2), and Internal Medicine (3), Rijnstate Hospital, Arnhem, The Netherlands.

Introduction

Fine needle aspiration (FNA) is standard practice for thyroid nodule evaluation. However, results may be non-diagnostic in up to 20 – 30% of aspirates, and false-negatives or false-positives occur in up to 10%. Moreover, repeat FNA may remain non-diagnostic in 10 – 50% of samples.

Aim

To examine the diagnostic yield of core needle biopsy (CNB) in patients with thyroid nodules requiring evaluation

Patients and Methods

Indications to perform a thyroid nodule CNB were: 1. Bethesda-I FNA, 2. Bethesda-III FNA, 3. Clinically suspect for malignancy, either primary or secondary, and 4. Clinical doubt remaining despite Bethesda-II classification.

Results

Between February 2015 and July 2018, 85 patients underwent CNB of a thyroid nodule. Age ranged from 28 – 88 years, and maximal nodule diameter from 9 – 70 mm. Forty-one patients had a CNB because of FNA’s with a B-I or B-III classification, and 44 because of a high clinical suspicion for malignancy, or persistent clinical diagnostic uncertainty. The first CNB was diagnostic in 81 patients (95.2%). Four patients required a second CNB because the amount or quality of the biopsy material was insufficient to establish a diagnosis. All but one of the second CNB’s were diagnostic. Four patients developed a small subcapsular hematoma, easily controlled by local pressure. Other complications were not observed.

Conclusion

Core needle biopsy of thyroid nodules, performed by experienced radiologists, is a safe procedure and is associated with a much higher diagnostic yield than FNA. We recommend CNB as a second line procedure if the first FNA is inconclusive. Primary CNB is recommended if clinical suspicion for primary or secondary cancer is high.