Combined fine-needle aspiration with core needle biopsy for assessing thyroid nodules: a more valuable diagnostic method?
Zhe Chen1 , Jia-jia Wang1, Dong-ming Guo1, Zhuo-zhi Dai3, Yu-xia Zhai1, Honghui Su2,2
1Department of Interventional Ultrasound, The Second Affifiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China, Shantou, China
2The Second Affifiliated Hospital of Shantou University Medical College, Shantou, China
3Department of Radiology, Shantou Central Hospital, Shantou, Guangdong, China , Shantou, China
Corresponding Author: Honghui Su ,Tel: +86075488915681, Fax: +86075488915681, Email: sdfecsjrk@126.com
Received: June 27, 2022;  Accepted: November 24, 2022.  Published online: January 5, 2023.
ABSTRACT
Objective: To evaluate the diagnostic value of combined fine-needle aspiration (FNA) with core needle biopsy (CNB) in thyroid nodules.
Methods:
FNA and CNB were performed simultaneously on 703 nodules. We compared the proportions of inconclusive results and the malignant diagnostic performance among FNA, CNB, and combined FNA/CNB for different nodule sizes.
Results:
Combined FNA/CNB showed lower proportions (2.8%, 4.9%, 2.0%, 3.8%, and 2.1%, respectively) of inconclusive results than CNB for all nodules (5.7%) (P<0.001), nodules ≤1.0 cm (7.3%) (P=0.063), nodules >1.0 cm (5.0%) (P<0.001), nodules ≤1.5 cm (7.9%) (P<0.001), and nodules >1.5 cm (3.9%) (P=0.016). The sensitivity of combined FNA/CNB in predicting malignancy was significantly higher than that of CNB (89.0% vs. 80.0%, P<0.001) and FNA (89.0% vs. 58.1%, P<0.001) for all nodules. Within the cases of American College of Radiology Thyroid and Imaging Reporting and Data System grades 4-5, in the subgroup of nodules ≤ 1.5 cm, combined FNA/CNB showed the best sensitivity in predicting malignancy (91.4%), significantly higher than that of CNB (81.0%, P<0.001) and FNA (57.8%, P<0.001). However, in the subgroup of nodules >1.5 cm, the difference between combined FNA/CNB and CNB was not significant (84.2% vs. 78.9%, P=0.500).
Conclusion:
Regardless of nodule size, combined FNA/CNB tended to yield lower proportions of inconclusive results than CNB and FNA alone and greater performance in diagnosing malignancy. The combined FNA/CNB technique may be a more valuable diagnostic method in cases of nodules <1.5 cm and at risk of malignancy than CNB and FNA alone.
Keywords: Thyroid nodule; Biopsy; Fine-needle aspiration; Core needle biopsy; Ultrasonography
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