Clin Exp Otorhinolaryngol.  2021 Feb;14(1):116-130. 10.21053/ceo.2020.00199.

Usage and Diagnostic Yield of Fine-Needle Aspiration Cytology and Core Needle Biopsy in Thyroid Nodules: A Systematic Review and Meta-Analysis of Literature Published by Korean Authors

• Ahn SH

• KMID: 2512890
• DOI: http://doi.org/10.21053/ceo.2020.00199

Abstract

Objectives
. The usefulness of core needle biopsy (CNB) for the diagnosis of thyroid nodules remains controversial, and preferences vary across hospitals. The purpose of this study was to assess the actual use of CNB in Korea and to analyze the advantages and disadvantages of CNB through a systematic review and meta-analysis of papers published by Korean authors.
Methods
. A meta-analysis of full-text publications published in English presenting data from Korea retrieved from the Embase literature database was performed.
Results
. CNB led to a significantly lower proportion of non-diagnostic results than fine-needle aspiration (FNA). However, the frequency of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) did not decrease as a result of performing CNB in nodules with initial AUS/FLUS results, while it increased in consecutive cases. A subcategory analysis of AUS/FLUS showed that the increased frequency of AUS/FLUS findings on CNB was due to more frequent diagnoses of architectural atypia and follicular neoplasm, which resulted in a higher frequency of inconclusive findings in consecutive cases compared to FNA. Hospitals favoring CNB had a higher proportion of AUS/FLUS diagnoses. Although the complication rate did not differ significantly between CNB and FNA, serious complications of CNB did occur.
Conclusion
. A reduced frequency of non-diagnostic results may be a definite advantage of CNB over FNA. However, the increased frequency of diagnoses of architectural atypia and follicular neoplasm should be considered when selecting CNB as a diagnostic tool.

Keyword

Thyroid Nodule; Core Needle Biopsy; Aspiration Biopsies, Fine Needle; Thyroid Carcinoma

Figure

• 

  Fig. 1. Flow diagram illustrating the literature search protocol. IHC, immunohistochemistry; US, ultrasound; DTC, differentiated thyroid carcinoma; ND, non-diagnostic; AUS/FLUS, atypia of undetermined significance/follicular lesion of undetermined significance; FN, follicular neoplasm.

• 

  Fig. 2. Forest plot of the proportional analysis of diagnostic categories between core needle biopsy (CNB) and fine-needle aspiration (FNA) performed in nodules initially classified as non-diagnostic or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS). (A) Proportion of non-diagnostic results in nodules with non-diagnostic results from initial FNA. Proportion of diagnoses in nodules with AUS/FLUS results from initial FNA: non-diagnostic result (B), AUS/FLUS (C), and follicular neoplasm/suspicious of follicular neoplasm (FN/SFN; D). CI, confidence interval.

• 

  Fig. 3. Comparison of pooled estimates of the proportions of diagnoses for each Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) category from consecutive data. The hatched bar indicates a statistically significant increase in diagnostic frequency. (A) Comparison of fine-needle aspiration (FNA) results between hospitals favoring core needle biopsy (CNB) or FNA. (B) Comparison of CNB and FNA results. AUS/FLUS, atypia of undetermined significance/follicular lesion of undetermined significance; FN/SFN, follicular neoplasm/suspicious for follicular neoplasm.

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  Fig. 4. Forest plot of the proportional analysis. (A) Diagnostic frequency of cellular and architectural atypia in atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) diagnosed by core needle biopsy (CNB) and fine-needle aspiration (FNA) cytology. (B) Comparison of risk of malignancy diagnosed by CNB and FNA: cellular atypia (B), architectural atypia (C), and follicular neoplasm (D). CI, confidence interval.

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