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Dolidze DD, Covantsev S, Chechenin GM, Pichugina NV, Bedina AV, Bumbu A. Core needle biopsy for thyroid nodules assessment-a new horizon? World J Clin Oncol 2024; 15:580-586. [DOI: 10.5306/wjco.v15.i5.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/29/2024] [Accepted: 04/10/2024] [Indexed: 05/21/2024] Open
Abstract
Ultrasound-guided fine-needle aspiration is the standard for evaluating thyroid nodules with a high safety profile and a relatively low number of non-diagnostic cytological findings. Nevertheless, this diagnostic method traditionally has its weak points. Several diagnostic categories such as Bethesda I, III and IV are not reliable for thyroid carcinoma risk assessment. Recent advancements in a core needle biopsy made it possible to use this tool as a new method for thyroid nodules evaluation. The main feature of this method is the use of thin needles (18-21G) and guns with an automatic trigger mechanism. The histological material collected with the use of a core needle biopsy is usually superior to cytological. Therefore, the core needle biopsy can be used as a complementary technique to a standard fine needle aspiration in difficult and dubious cases of thyroid neoplasia with uncertain malignant potential.
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Affiliation(s)
- David D Dolidze
- Department of Clinical Research and Development, Botkin Hospital, Moscow 125284, Russia
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, Moscow 125445, Russia
| | - Serghei Covantsev
- Department of Clinical Research and Development, Botkin Hospital, Moscow 125284, Russia
- Emergency Surgery №76, Botkin Hospital, Moscow 125284, Russia
| | - Grigorii M Chechenin
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, Moscow 125445, Russia
- Department of Surgery, Botkin Hospital, Moscow 125284, Russia
| | - Natalia V Pichugina
- Department of Medical Ultrasonography, Botkin Hospital, Moscow 125284, Russia
| | - Anastasia V Bedina
- Medicine, Moscow State Medical University I.M. Sechenov, Moscow 119048, Russia
| | - Anna Bumbu
- Department of Oncology, Botkin Hospital, Moscow 125284, Russia
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Jung CK. Reevaluating diagnostic categories and associated malignancy risks in thyroid core needle biopsy. J Pathol Transl Med 2023; 57:208-216. [PMID: 37460395 PMCID: PMC10369141 DOI: 10.4132/jptm.2023.06.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
As the application of core needle biopsy (CNB) in evaluating thyroid nodules rises in clinical practice, the 2023 Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules have officially recognized its value for the first time. CNB procures tissue samples preserving both histologic structure and cytologic detail, thereby supplying substantial material for an accurate diagnosis and reducing the necessity for repeated biopsies or subsequent surgical interventions. The current review introduces the risk of malignancy within distinct diagnostic categories, emphasizing the implications of noninvasive follicular thyroid neoplasm with papillary-like nuclear features on these malignancy risks. Prior research has indicated diagnostic challenges associated with follicular-patterned lesions, resulting in notable variation within indeterminate diagnostic categories. The utilization of mutation-specific immunostaining in CNB enhances the accuracy of lesion classification. This review underlines the essential role of a multidisciplinary approach in diagnosing follicular-patterned lesions and the potential of mutation-specific immunostaining to strengthen diagnostic consensus and inform patient management decisions.
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Affiliation(s)
- Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Chen Z, Wang JJ, Guo DM, Zhai YX, Dai ZZ, Su HH. Combined fine-needle aspiration with core needle biopsy for assessing thyroid nodules: a more valuable diagnostic method? Ultrasonography 2023; 42:314-322. [PMID: 36935592 PMCID: PMC10071058 DOI: 10.14366/usg.22112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/19/2022] [Accepted: 11/24/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE This study aimed 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 diagnostic performance for malignancy among FNA, CNB, and combined FNA/CNB for different nodule sizes. RESULTS Combined FNA/CNB showed lower proportions of inconclusive results than CNB for all nodules (2.8% vs. 5.7%, P<0.001), nodules ≤1.0 cm (4.9% vs. 7.3%, P=0.063), nodules >1.0 cm (2.0% vs. 5.0 %, P<0.001), nodules ≤1.5 cm (3.8% vs. 7.9 %, P<0.001), and nodules >1.5 cm (2.1% vs. 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 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 or FNA alone and exhibited higher performance in diagnosing malignancy. The combined FNA/CNB technique may be a more valuable diagnostic method for nodules ≤1.5 cm and nodules with a risk of malignancy than CNB and FNA alone.
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Affiliation(s)
- Zhe Chen
- Department of Interventional Ultrasound, The Second Affiliated Hospital of Shantou University Medical College, Shantou,
China
| | - Jia-jia Wang
- Department of Interventional Ultrasound, The Second Affiliated Hospital of Shantou University Medical College, Shantou,
China
| | - Dong-ming Guo
- Department of Interventional Ultrasound, The Second Affiliated Hospital of Shantou University Medical College, Shantou,
China
| | - Yu-xia Zhai
- Department of Interventional Ultrasound, The Second Affiliated Hospital of Shantou University Medical College, Shantou,
China
| | - Zhuo-zhi Dai
- Department of Radiology, Shantou Central Hospital, Shantou,
China
| | - Hong-hui Su
- Department of Interventional Ultrasound, The Second Affiliated Hospital of Shantou University Medical College, Shantou,
China
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Chen Z, Qiu ZX, Guo DM, Wang JJ, Guo HT, Su HH, Dai ZZ, Zhai YX. Ultrasound features affecting the sample adequacy after fine-needle aspiration of thyroid nodules with different risk stratification. Clin Hemorheol Microcirc 2023; 83:377-386. [PMID: 36744332 DOI: 10.3233/ch-221659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The inadequacy samples caused by the internal characteristic structure of thyroid nodules are difficult to be solved. OBJECTIVE To evaluate the ultrasound features affecting the sample adequacy after fine-needle aspiration (FNA) of thyroid nodules with different risk stratification. METHODS 592 thyroid nodules that underwent ultrasound-guided FNA were included in this retrospective study. The sample obtained by FNA were classified as inadequacy and adequacy according to the cytopathological results. Ultrasound features (ie., size, position, cystic predominance, composition, echo, shape, margin, and superficial annular calcification status) of the nodules were recorded and compared between the inadequacy sample group and adequacy sample group. RESULTS Multiple logistic regression shows that preponderant cystic proportion (OR, 0.384; P = 0.041), extremely hypoechogenicity and hypoechogenicity (OR, 6.349; P = 0.006) were the independent influencing factors of inadequate samples after FNA in benign expected nodules. In addition, nodule size ≤10 mm (OR, 1.960; P = 0.010) and superficially annular calcification (OR, 4.600; P < 0.001) were independent influencing factors for inadequate samples after FNA in malignant expected nodules. CONCLUSION The ultrasound features of hypoechogenicity or high cystic proportion in benign expected nodules and that of small size or annular calcification in malignant expected nodules were the risk factors for inadequacy samples by US-guided FNA.
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Affiliation(s)
- Zhe Chen
- Department of Interventional Ultrasound, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zhong-Xian Qiu
- Department of Ultrasound, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Dong-Ming Guo
- Department of Interventional Ultrasound, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jia-Jia Wang
- Department of Ultrasound, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Hai-Ting Guo
- Department of Endocrinology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Hong-Hui Su
- Department of Interventional Ultrasound, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zhuo-Zhi Dai
- Department of Radiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Yu-Xia Zhai
- Department of Ultrasound, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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Permanent vocal fold paralysis after ultrasound-guided core needle biopsy of thyroid nodule. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kim K, Bae JS, Kim JS, Jung SL, Jung CK. Diagnostic Performance of Thyroid Core Needle Biopsy Using the Revised Reporting System: Comparison with Fine Needle Aspiration Cytology. Endocrinol Metab (Seoul) 2022; 37:159-169. [PMID: 35255608 PMCID: PMC8901962 DOI: 10.3803/enm.2021.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/06/2022] [Indexed: 11/11/2022] Open
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.
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Affiliation(s)
- Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - So Lyung Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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Na DG. Factors to consider when comparing the diagnostic performance of fine-needle aspiration and core-needle biopsy for thyroid nodules. Endocrine 2021; 71:524-525. [PMID: 33400170 DOI: 10.1007/s12020-020-02562-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si Gangwon-do, 25440, Republic of Korea.
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