Endocrinol Metab.  2022 Feb;37(1):159-169. 10.3803/EnM.2021.1299.

Diagnostic Performance of Thyroid Core Needle Biopsy Using the Revised Reporting System: Comparison with Fine Needle Aspiration Cytology

• Kim K
• Bae JS
• Kim JS
• Jung SL
• Jung CK

• KMID: 2527146
• DOI: http://doi.org/10.3803/EnM.2021.1299

Abstract

Background
We aim to validate the diagnostic performance of thyroid core needle biopsy (CNB) for diagnosing malignancy in clinical settings to align with the changes made in recently updated thyroid CNB guidelines.
Methods
We retrospectively analyzed 1,381 thyroid CNB and 2,223 fine needle aspiration (FNA) samples. The FNA and CNB slides were interpreted according to the Bethesda System for Reporting Thyroid Cytopathology and updated practice guidelines for thyroid CNB, respectively.
Results
Compared to FNA, CNB showed lower rates of inconclusive results: categories I (2.8% vs. 11.2%) and III (1.2% vs. 6.2%), and higher rates of categories II (60.9% vs. 50.4%) and IV (17.5% vs. 2.0%). The upper and lower bounds of the risk of malignancy (ROM) for category IV of CNB were 43.2% and 26.6%, respectively. The CNB subcategory IVb with nuclear atypia had a higher ROM than the subcategory without nuclear atypia (40%–62% vs. 23%–36%). In histologically confirmed cases, there was no significant difference in the diagnostic performance between CNB and FNA for malignancy. However, neoplastic diseases were more frequently detected by CNB than by FNA (88.8% vs. 77.6%, P=0.046). In category IV, there was no difference in unnecessary surgery rate between CNB and FNA (4.7% vs. 6.9%, P=0.6361).
Conclusion
Thyroid CNB decreased the rate of inconclusive results and showed a higher category IV diagnostic rate than FNA. The revised guidelines for thyroid CNB proved to be an excellent reporting system for assessing thyroid nodules.

Keyword

Biopsy, fine-needle; Biopsy, large-core needle; Retrospective studies; Unnecessary procedures; Thyroid neoplasms; Thyroid nodule; Thyroid cancer, papillary

Figure

• 

  Fig. 1 Expected diagnostic performance of core needle biopsy (CNB) and fine needle aspiration (FNA). (A) The expected positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of thyroid malignancy with a variable prevalence of the disease. (B) The diagnosis of thyroid malignancy and noninvasive follicular thyroid neoplasm with papillary-like nuclear feature (NIFTP) with a variable prevalence of the disease. (C) The diagnosis of surgical diseases including malignancy, NIFTP, and benign neoplasm with a variable prevalence of the disease. The thin red and green lines represent the corresponding 95% confidence intervals for PPV and NPV, respectively.

• 

  Fig. 2 Rates of (A) surgical disease and (B) malignancy according to the size of the nodule in patients who underwent diagnostic surgery for thyroid nodules with a preoperative diagnosis of follicular neoplasm by core needle biopsy (CNB) or fine needle aspiration (FNA) cytology.

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