The Role of Core-Needle Biopsy for Thyroid Nodules with Initially Nondiagnostic Fine-Needle Aspiration Results: A Systematic Review and Meta-Analysis |
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| Institution: | 1. From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea;2. Department of Radiology, Namwon Medical Center, Jeollabuk-Do, Republic of Korea;3. Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea;4. Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea, and;5. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.;1. From the Division of Diabetes and Endocrinology Metabolism, University of Minnesota, Minneapolis, Minnesota;2. Occupational and Environmental Medicine, Health Partners, Minneapolis, Minnesota;3. Medicine Department, HCMC, Minneapolis, Minnesota;4. Endocrinology Department, HCMC, Minneapolis, Minnesota.;1. Institute for Transfusion Medicine and Immunohematology, Division of Translational Cell Therapy, Goethe University, Frankfurt and German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt, Germany;2. Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, United States;3. Department of Pediatric Hematology and Oncology, Division of Pediatric Stem Cell Transplantation and Cell Therapy, University Hospital Eppendorf, Hamburg, Germany;1. Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Department of Infectious Diseases and Institute for Virus Hepatitis, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China;2. Department of Infectious Diseases of the Ninth People''s Hospital of Chongqing Province, Chongqing, China |
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| Abstract: | Objective: This study evaluated the prevalence of nondiagnostic results, diagnostic performance, and complications of core-needle biopsy (CNB) compared with repeat fine-needle aspiration (FNA) for thyroid nodules with previous nondiagnostic FNA findings.Methods: The Ovid-MEDLINE and EMBASE databases were thoroughly searched for studies evaluating CNB or repeat FNA for thyroid nodules with initially nondiagnostic FNA results. Pooled proportions of nondiagnostic results of CNB and repeat FNA were calculated. A meta-analysis was performed to evaluate the diagnostic accuracy of CNB and repeat FNA for a diagnosis of malignancy using a bivariate random-effects model. Complication rates were also evaluated.Results: A review of 52 articles identified 4 eligible articles, involving 1,028 patients with 1,028 thyroid nodules, which were included in the meta-analysis. CNB demonstrated significantly lower rates of nondiagnostic results (6.4%) than repeat FNA (36.5%) (P<.0001). In the 3 studies that analyzed the diagnostic accuracy of CNB in diagnosing malignancy, CNB demonstrated significantly higher summary estimates of sensitivity (89.8%) than repeat FNA (60.6%) (P = .022), but summary specificity did not differ between CNB (99.2%) and repeat FNA (99.0%) (P = .576). None of the patients who underwent CNB or repeat FNA experienced any major complications.Conclusion: CNB demonstrates lower rates of nondiagnostic results and higher diagnostic accuracy than repeat FNA. CNB, rather than repeat FNA, can be utilized to diagnose thyroid nodules previously nondiagnostic on FNA.Abbreviations:CI = confidence intervalCNB = core-needle biopsyFNA = fine-needle aspirationSROC = summary receiver operating characteristicUS = ultrasound |
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