Comparison of ultrasound-guided fine-needle aspiration biopsy with core-needle biopsy in the evaluation of thyroid nodules.
OBJECTIVE
To compare the diagnostic rate of ultra-sound-guided fine-needle aspiration biopsy (FNAB) with the diagnostic rate of combined FNAB and core-needle biopsy in the evaluation of nodular thyroid disease.


METHODS
We performed a retrospective case-control study by reviewing charts of patients who underwent ultra-sound-guided FNAB and core-needle biopsy of the thyroid at a tertiary referral center from January 1999 to December 2001. Results were classified as diagnostic (negative, suspicious, or positive for malignancy) or nondiagnostic. These findings were compared with an age- and sex-matched control group who underwent only FNAB. Complications between the groups were reviewed.


RESULTS
The patient group consisted of 320 patients who underwent 340 ultrasound-guided fine-needle aspiration and core-needle biopsies of the thyroid; the control group consisted of 311 patients who underwent 340 FNABs. There was no significant difference in the nondiagnostic rates between groups--12.9% in patients who had FNAB-only compared with 10.9% in patients who had both procedures (proportion difference, -2.1%; 95% confidence interval, -7.0% to 2.9%; P = .41). There was a trend towards an increased incidence of hematoma and infection in the core biopsy group. In the group that underwent FNAB and core-needle biopsies, 10 patients (3.1%) developed biopsy-specific complications (hematomas in 8 patients, biopsy site infections in 2 patients). In the FNAB-only group, 3 patients (1.0%) developed hematomas; there was no incidence of infection.


CONCLUSIONS
In the evaluation of thyroid nodules, the addition of core-needle biopsies to FNAB confers little benefit in decreasing the nondiagnostic rates and may be associated with increased complications. Core-needle biopsies should not be routinely performed in the evaluation of thyroid nodules, but rather, patient selection for the more invasive core biopsy should be done judiciously.
Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota, USA. khoo.teckkim@mayo.edu
Teck-Kim
TK
Khoo
Claire H
CH
Baker
Julie
J
Hallanger-Johnson
Andrea M
AM
Tom
Clive S
CS
Grant
Carl C
CC
Reading
Thomas J
TJ
Sebo
John C
JC
Morris
D044963:Biopsy, Fine-Needle / Q000295:instrumentation / Q000379:methods*; D001707:Biopsy, Needle / Q000379:methods*; D016022:Case-Control Studies; D019160:Endosonography; D006801:Humans; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000473:pathology*; D016606:Thyroid Nodule / Q000473:pathology*