title: Sonographically suspicious thyroid nodules with initially benign cytologic results: the role of a core needle biopsy.
abstract: OBJECTIVE
  To evaluate the diagnostic role of core needle biopsy (CNB) in sonographically suspicious thyroid nodules with initially benign cytologic results through a histologic analysis of CNB specimens.
  
  
  METHODS
  Between October 2008 and July 2011, 88 patients underwent ultrasound (US)-guided CNB for initially benign cytologic results with suspicious US features at our institution. In all, 85 patients with 85 focal thyroid nodules were included in the study after surgery or concordant benign readings following fine-needle aspiration biopsy (FNAB) and CNB. We evaluated the risk of malignancy, diagnostic performance of CNB, and histologic findings for these nodules.
  
  
  RESULTS
  Of the 85 nodules, 28 (32.9%) were histologically upgraded on CNB specimens including one case of atypia of undetermined significance (AUS), seven cases of follicular neoplasm, one case of suspicious for malignancy, and 19 cases of malignancy. Of these, 27 (31.8%) were finally confirmed as malignant, and one as follicular adenoma at surgery. The 27 malignant nodules included 21 papillary thyroid carcinomas (PTCs), five follicular thyroid carcinomas, and one Hürthle cell carcinoma. All PTCs were diagnosed from CNB readings of AUS suspicious for malignancy or malignancy. Follicular thyroid carcinomas and Hürthle cell carcinoma were diagnosed from CNB readings of follicular neoplasm. Histologic analysis of benign CNB specimens revealed severe fibrosis (96.4%), hemosiderin (21.4%), calcification (17.9%), granulation tissue (12.5%), and focal lymphocytic thyroiditis (12.5%).
  
  
  CONCLUSIONS
  The histologic information obtained by analysis of CNB specimens may enable more confident diagnosis for benign nodules with suspicious US features and reduce the need for repetitive FNABs or diagnostic surgery.
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea.
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Ha
authors.forename: Jung Hwan
authors.initials: JH
authors.lastname: Baek
authors.forename: Jeong Hyun
authors.initials: JH
authors.lastname: Lee
authors.forename: Dong Eun
authors.initials: DE
authors.lastname: Song
authors.forename: Jae Kyun
authors.initials: JK
authors.lastname: Kim
authors.forename: Young Kee
authors.initials: YK
authors.lastname: Shong
authors.forename: Suck Joon
authors.initials: SJ
authors.lastname: Hong
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D018249:Adenoma, Oxyphilic; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D062005:Biopsy, Large-Core Needle; D002277:Carcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D002291:Carcinoma, Papillary; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography; D055815:Young Adult