title: Usefulness of core needle biopsy for thyroid nodules with macrocalcifications: comparison with fine-needle aspiration.
abstract: BACKGROUND
  This study was performed to determine the benefits of core needle biopsy (CNB), as compared with fine-needle aspiration (FNA), for the diagnosis of thyroid nodules with macrocalcifications.
  
  
  METHODS
  The institutional review board approved this retrospective study, and informed consent was waived. From February 2010 to March 2012, the study included 147 thyroid nodules with macrocalcification of 145 consecutive patients who underwent simultaneous FNA and CNB for each nodule. Diagnostic accuracy and inconclusive diagnoses, including nondiagnostic reading and atypia of undetermined significance or follicular lesion of undetermined significance reading were compared among FNA, CNB, and a combination of FNA and CNB (FNA/CNB) using McNemar's test; the benefits of CNB were calculated.
  
  
  RESULTS
  Compared to FNA, CNB and FNA/CNB showed fewer inconclusive diagnoses (FNA vs. CNB: 62/147 [42.2%] vs. 14/147 [9.5%], p<0.001; FNA vs.
  62/147 [42.2%] vs. 14/147 [9.5%], p<0.001), resulting in the avoidance of repeat FNA or diagnostic surgery in 48 of 62 patients (77.4%, respectively in CNB and FNA/CNB) who would have undergone these procedures if only FNA was performed. Compared to FNA, FNA/CNB showed higher sensitivity and accuracy (sensitivity: 23/32 [71.9%] vs. 31/32 [96.9%], p=0.008; accuracy: 77/86 [89.5%] vs. 85/86 [98.8%], p=0.008), resulting in avoidance of delayed surgery in eight of nine patients (88.9%) with thyroid cancer in whom the surgery would have been missed if FNA only had been performed.
  
  
  CONCLUSIONS
  In the workup of thyroid nodules with macrocalcification, compared with FNA alone, FNA/CNB decreases inconclusive diagnoses and increases sensitivity, thereby reducing repeated FNA procedures, diagnostic surgeries, and delayed therapeutic surgeries.
authors: 1Department of Radiology, Seoul National University Hospital, Seoul, Korea.|2Department of Radiology, Chungbuk National University Hospital, Chungbuk, Korea.
authors: Kyung Sik
authors: KS
authors: Yi
authors: 1Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors: Ji-Hoon
authors: JH
authors: Kim
authors: Dong Gyu
authors: DG
authors: Na
authors: 4Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
authors: Hyobin
authors: H
authors: Seo
authors: 5Department of Pathology, Seoul National University Hospital, Seoul, Korea.|6Department of Preventive Medicine, Graduate School of Public Health, Seoul National University Hospital, Seoul, Korea.
authors: Hye Sook
authors: HS
authors: Min
authors: 5Department of Pathology, Seoul National University Hospital, Seoul, Korea.
authors: Jae-Kyung
authors: JK
authors: Won
authors: 1Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors: Tae Jin
authors: TJ
authors: Yun
authors: 7Department of Radiology, Korea University Guro Hospital, Seoul, Korea.
authors: Inseon
authors: I
authors: Ryoo
authors: 8Department of Radiology, SNU Boramae Medical Center, Seoul, Korea.
authors: Su Chin
authors: SC
authors: Kim
authors: 1Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors: Seung Hong
authors: SH
authors: Choi
authors: 1Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors: Chul-Ho
authors: CH
authors: Sohn
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D062005:Biopsy, Large-Core Needle; D002114:Calcinosis / Q000175:diagnosis / Q000473:pathology*; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology*; D002291:Carcinoma, Papillary; D018265:Carcinoma, Papillary, Follicular / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000473:pathology*; D016606:Thyroid Nodule / Q000175:diagnosis / Q000473:pathology*