Korean J Radiol.  2018 Aug;19(4):656-664. 10.3348/kjr.2018.19.4.656.

Evaluation of Modified Core-Needle Biopsy in the Diagnosis of Thyroid Nodules

• Ahn S
• Jung S
• Kim JY
• Shin JH
• Hahn SY
• Oh YL

• KMID: 2413694
• DOI: http://doi.org/10.3348/kjr.2018.19.4.656

Abstract

OBJECTIVE
Core needle biopsy (CNB) of the thyroid is an additional diagnostic method for non-diagnostic or indeterminate cytology samples. We sought to evaluate a new modified core biopsy technique and compare the concordance of its diagnosis with the final diagnosis of the surgically resected specimen.
MATERIALS AND METHODS
A retrospective analysis was conducted on 842 patients who had a thyroid CNB with or without a previous fine-needle aspiration from August 2002 to March 2015; 38% of patients ultimately underwent thyroidectomy. We divided the patients into two groups for comparison: conventional group (n = 329) and new modified technique group (n = 513) that enabled sampling of not only the lesion but also the margin and surrounding parenchyma. The diagnostic conclusiveness of CNB and concordant rate with thyroidectomy was compared between the two groups.
RESULTS
The overall diagnostic conclusiveness did not exhibit a significant increase (77% in the conventional technique group and 75% in the modified technique group, p = 0.408). In terms of the diagnostic concordance rate between CNB and thyroidectomy, no overall significant increase was observed (83% in the conventional technique group and 88% in the modified technique group, p = 0.194). However, only in follicular-patterned lesions (nodular hyperplasia, follicular neoplasm, and follicular variant of papillary thyroid carcinoma), a significant increase in the diagnostic concordance rate was observed (83% in the conventional group and 94% in the modified technique group, p = 0.033).
CONCLUSION
Modified CNB technique can be beneficial for the accurate diagnosis of follicular-patterned thyroid lesions.

Keyword

Thyroid nodule; Core needle biopsy (CNB); Follicular-patterned lesion; Fine-needle aspiration (FNA); Biopsy technique; Diagnosis

MeSH Terms

Biopsy*
Biopsy, Fine-Needle
Biopsy, Large-Core Needle
Diagnosis*
Humans
Hyperplasia
Methods
Retrospective Studies
Thyroid Gland*
Thyroid Nodule*
Thyroidectomy

Figure

• 

  Fig. 1 Core biopsy specimens using modified CNB technique, H&E staining (× 40).This case was diagnosed as follicular variant of papillary thyroid carcinoma.Biopsy specimens were retrieved from surrounding normal parenchyma (A), capsular portion of nodule (B), and intra-nodular target (C). CNB = core needle biopsy, H&E = hematoxylin and eosin

• 

  Fig. 2 CNB examples of various histological types.A, B. CNB of nodular hyperplasia (H&E × 20, A; H&E × 200, B). C, D. CNB of follicular adenoma (H&E × 20, C; H&E × 200, D). E, F. CNB of follicular variant of papillary thyroid carcinoma (H&E × 20, E; H&E × 200, F).

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