title: Comparison of the efficacy and safety of ultrasound-guided core needle biopsy versus fine-needle aspiration for evaluating thyroid nodules.
abstract: OBJECTIVE
  Ultrasound-guided core needle biopsy (UG-CNB) is a procedure that is often performed either after repeated inadequate or nondiagnostic ultrasound-guided fine-needle aspiration (UG-FNA) or in combination with UG-FNA in the evaluation of thyroid nodules. The purpose of this study was to compare the efficacy and safety of UG-CNB and UG-FNA for evaluating thyroid nodules.
  
  
  METHODS
  This was a retrospective study of 350 consecutive patients who had thyroid nodules biopsied by UG-CNB or UG-FNA from January 2007 until November 2011 at our institution. Biopsy results were compared to the surgical specimen pathology reports for the 105 patients who subsequently underwent hemi- or total thyroidectomy in order to determine whether UG-CNB has advantages over UG-FNA for diagnosing thyroid malignancy and neoplasia.
  
  
  RESULTS
  Out of 461 thyroid nodules biopsied from 350 patients, 365 (79%) involved UG-CNB and 96 (21%) involved UG-FNA. The UG-FNA biopsy group had a significantly higher rate of inadequate sampling than the UG-CNB group (P<.0001; Fisher's exact test). Out of 365 UG-CNB samples, 6 (2%) were deemed inadequate for histologic diagnosis, whereas 26 (27%) of the 96 UG-FNA samples were considered inadequate for cellularity. Comparison of biopsy results with the surgical specimen pathology reports revealed that the diagnostic accuracy of UG-CNB and UG-FNA for detecting malignancy was similar, at 89 and 94%, respectively (not significant by Fisher's exact test). However, the UG-CNB group had a higher detection rate for benign follicular lesions compared to the UG-FNA group (65% versus 48% for UG-FNA; P = .002). Although UG-FNA detected neoplasia with high sensitivity (100%), the specificity was poor (30%). Neither biopsy group had any significant immediate or delayed procedure-related complications.
  
  
  CONCLUSIONS
  Our study demonstrated that UG-CNB is safe and is less likely to result in a nondiagnostic biopsy. The accuracy of the UG-CNB technique is similar to that of UG-FNA for detecting thyroid malignancy.
authors.affiliation: Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, California.
authors.forename: Bihong T
authors.initials: BT
authors.lastname: Chen
authors.affiliation: Department of Endocrinology, LMC Diabetes and Endocrinology, Calgary, Alberta, Canada.
authors.forename: Akshay B
authors.initials: AB
authors.lastname: Jain
authors.affiliation: Department of Information Science/Biostatistics, City of Hope National Medical Center, Duarte, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Dagis
authors.affiliation: Department of Pathology, City of Hope National Medical Center, Duarte, California.
authors.forename: Peiguo
authors.initials: P
authors.lastname: Chu
authors.affiliation: Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, California.
authors.forename: Lalit
authors.initials: L
authors.lastname: Vora
authors.affiliation: Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, California.
authors.forename: Ellie
authors.initials: E
authors.lastname: Maghami
authors.affiliation: Department of Endocrinology, City of Hope National Medical Center, Duarte, California.
authors.forename: Behrouz
authors.initials: B
authors.lastname: Salehian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016606:Thyroid Nodule / Q000473:pathology*; D018084:Ultrasonography, Interventional