title: The use of core needle biopsy as first-line in diagnosis of thyroid nodules reduces false negative and inconclusive data reported by fine-needle aspiration.
abstract: BACKGROUND
  The reported reliability of core needle biopsy (CNB) is high in assessing thyroid nodules after inconclusive fine-needle aspiration (FNA) attempts. However, first-line use of CNB for nodules considered at risk by ultrasonography (US) has yet to be studied. The aim of this study were: 1) to evaluate the potential merit of using CNB first-line instead of conventional FNA in thyroid nodules with suspicious ultrasonographic features; 2) to compare CNB and FNA as a first-line diagnostic procedure in thyroid lesions at higher risk of cancer.
  
  
  METHODS
  Seventy-seven patients with a suspicious-appearing, recently discovered solid thyroid nodule were initially enrolled as study participants. No patients had undergone prior thyroid fine-needle aspiration/biopsy. Based on study design, all patients were proposed to undergo CNB as first-line diagnostic aspiration, while those patients refusing to do so underwent conventional FNA.
  
  
  RESULTS
  Five patients refused the study, and a total of 31 and 41 thyroid nodules were subjected to CNB and FNA, respectively. At follow-up, the overall rate of malignancy was of 80% (CNB, 77%; FNA, 83%). However, the diagnostic accuracy of CNB (97%) was significantly (P < 0.05) higher than that of FNA (78%). In one benign lesion, CNB was inconclusive. Four (12%) of the 34 cancers of the FNA group were not initially diagnosed because of false negative (N = 1), indeterminate (N = 2) or not adequate (N = 1) samples.
  
  
  CONCLUSIONS
  CNB can reduce the false negative and inconclusive results of conventional FNA and should be considered a first-line method in assessing solid thyroid nodules at high risk of malignancy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Trimboli
authors.forename: Naim
authors.initials: N
authors.lastname: Nasrollah
authors.forename: Leo
authors.initials: L
authors.lastname: Guidobaldi
authors.forename: Silvia
authors.initials: S
authors.lastname: Taccogna
authors.forename: Davide Domenico
authors.initials: DD
authors.lastname: Cicciarella Modica
authors.forename: Stefano
authors.initials: S
authors.lastname: Amendola
authors.forename: Francesco
authors.initials: F
authors.lastname: Romanelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Lenzi
authors.affiliation: Department of Surgical and Medical Sciences, Sapienza University, Ospedale S, Andrea, Rome, Italy. giuseppe.nigri@uniroma1.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.forename: Marco
authors.initials: M
authors.lastname: Centanni
authors.forename: Luca
authors.initials: L
authors.lastname: Giovanella
authors.forename: Stefano
authors.initials: S
authors.lastname: Valabrega
authors.forename: Anna
authors.initials: A
authors.lastname: Crescenzi
mesh_terms: D044963:Biopsy, Fine-Needle; D062005:Biopsy, Large-Core Needle; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000145:classification / Q000175:diagnosis*; D016606:Thyroid Nodule / Q000175:diagnosis*; D014463:Ultrasonography