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Thyroid nodules with initially non-diagnostic, fine-needle aspiration results: comparison of core-needle biopsy and repeated fine-needle aspiration

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Abstract

Objective

To evaluate the role of core-needle biopsy (CNB) by comparing the results of CNB and repeated fine-needle aspiration (FNA) for thyroid nodules with initially non-diagnostic FNA results.

Methods

From October 2008 to December 2011, 360 nodules – 180 consecutive repeated FNAs and 180 consecutive CNBs –– from 360 patients (83 men, 277 women; mean age, 54.4 years) with initially non-diagnostic FNA results were analyzed retrospectively. The incidence of non-diagnostic results, inconclusive results, diagnostic surgery, and diagnostic performance of repeated FNA and CNB were assessed, and factors affecting second non-diagnostic results were evaluated.

Results

CNB achieved a significantly lower non-diagnostic and inconclusive rate than repeated FNA (1.1 % versus 40.0 %, P < 0.001; 7.2 % versus 72.0 %, P < 0.001). All diagnostic performances with CNB were higher than repeated FNA. The diagnostic surgery rate was lower with CNB than with repeated FNA (3.6 % versus 16.7 %, P = 0.047). Multivariate logistic regression analysis showed that repeated FNA was the most important factor for second non-diagnostic results (OR = 56.06, P < 0.001), followed by nodules with rim calcification (OR = 7.46, P = 0.003).

Conclusions

CNB is more useful than repeated FNA for reducing the number of non-diagnostic and inconclusive results and for preventing unnecessary diagnostic surgery for thyroid nodules with initially non-diagnostic FNA results.

Key Points

• Core-needle biopsy achieved a lower number of non-diagnostic and inconclusive results.

• Core-needle biopsy achieved better diagnostic performance.

• Use of core-needle biopsy could prevent unnecessary diagnostic surgery.

• Repeated fine-needle aspiration was significantly associated with a second non-diagnosis.

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Abbreviations

US:

ultrasound

FNA:

fine-needle aspiration

CNB:

core-needle biopsy

AUS:

atypia of undetermined significance

FLUS:

follicular lesion of undetermined significance

FN:

follicular neoplasm

SFN:

suspected follicular neoplasm

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Acknowledgement

The scientific guarantor of this publication is Jung Hwan Baek. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. This retrospective study was approved by the Institutional Review Board, and required neither patient approval nor informed consent for review of the images and medical records. However, informed consent for FNA or CNB was obtained from all patients prior to biopsy. Some nodules with CNB (n = 123) in this study have been used in a previously published article (Yeon et al. Radiology 2013; 268(1):274–80), which evaluated the role of CNB in thyroid nodules with initially non-diagnostic cytological results. In our study, we enrolled a relatively large number of study subjects (n = 180) for CNB and repeated FNA (n = 180) as a control group. Therefore, we believe that our study results provide more valuable information and options for both clinicians and patients to avoid unnecessary diagnostic surgery. Methodology: retrospective case-control study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Korea

    Sang Hyun Choi, Jung Hwan Baek, Jeong Hyun Lee, Young Jun Choi & Min Ji Hong

  2. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Korea

    Dong Eun Song

  3. Department of Radiology, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Korea

    Jae Kyun Kim

  4. Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Korea

    Jong Ho Yoon

  5. Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Korea

    Won Bae Kim

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  1. Sang Hyun Choi
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Correspondence to Jung Hwan Baek.

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Choi, S.H., Baek, J.H., Lee, J.H. et al. Thyroid nodules with initially non-diagnostic, fine-needle aspiration results: comparison of core-needle biopsy and repeated fine-needle aspiration. Eur Radiol 24, 2819–2826 (2014). https://doi.org/10.1007/s00330-014-3325-4

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  • DOI: https://doi.org/10.1007/s00330-014-3325-4

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