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.
Khoo
Teck-Kim
TK
Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota, USA. khoo.teckkim@mayo.edu
Baker
Claire H
CH
Hallanger-Johnson
Julie
J
Tom
Andrea M
AM
Grant
Clive S
CS
Reading
Carl C
CC
Sebo
Thomas J
TJ
Morris
John C
JC
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*