Comparison of diagnostic accuracy, sampling satisfaction, and incidence of complications between ultrasound-guided core needle biopsy and fine needle aspiration biopsy of thyroid nodules: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Jingtai , HOU Lingmi , TANG Yunhui , QIAN Shuangqiang , PU Hongyu ,  GAO Yanchun

Department of Thyroid and Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

GAO Yanchun, Email: boyang11111@163.com

Keywords：

thyroid nodule; fine needle aspiration biopsy; core needle biopsy; ultrasound guidance; meta analysis

DOI：

10.7507/1007-9424.202011036

Video：

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Objective To compare the diagnostic accuracy, sampling satisfaction, and safety of ultrasound-guided core needle biopsy (CNB) and fine needle aspiration biopsy (FNA) for thyroid nodules.Methods The databases of PubMed, Medline, Web of Science, Cochrane Library, Wanfang, CNKI, and CBM were searched to collect the relevant studies on the diagnostic performance, sampling satisfaction, and safety of ultrasound-guided CNB and FNA for thyroid nodules. Revman 5.3 and Stata 15 software were used for meta-analysis.Results A total of 24 studies involving 25 388 patients were included. Meta analysis showed that: compared with CNB, FNA had poor diagnostic accuracy ［OR=0.26, 95%CI (0.15, 0.46), P<0.000 01］, poor sampling satisfaction ［OR=0.20, 95%CI (0.12, 0.33), P<0.000 01］, lower incidence of total complications ［OR=0.28, 95%CI (0.16, 0.50), P<0.000 1］, and lower incidence of bleeding after biopsy ［OR=0.62, 95%CI (0.48, 0.81), P=0.000 3］. However, there was no significant difference in the pain score ［WMD=–0.21, 95%CI (–0.57, 0.15), P=0.26］ between the two groups. Subgroup analysis showed that there was no significant difference in the accuracy of biopsy diagnosis of thyroid nodules with diameter less than 10 mm between the two groups ［OR=0.52, 95%CI (0.15, 1.81), P=0.30］, however, the accuracy of CNB in the diagnosis of thyroid nodules with diameter ≥ 10 mm was still better than FNA ［OR=0.26, 95%CI (0.12, 0.56), P=0.000 5］.Conclusions Compared with FNA, ultrasound-guided CNB has a certain advantages in sampling satisfaction and the diagnosis accuracy of thyroid nodules with diameter ≥ 10 mm. CNB is better than FNA, but will bring higher risk of complication.

Citation： CHEN Jingtai, HOU Lingmi, TANG Yunhui, QIAN Shuangqiang, PU Hongyu, GAO Yanchun. Comparison of diagnostic accuracy, sampling satisfaction, and incidence of complications between ultrasound-guided core needle biopsy and fine needle aspiration biopsy of thyroid nodules: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(8): 1062-1069. doi: 10.7507/1007-9424.202011036 Copy

1.	中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中华核医学与分子影像杂志, 2013, 33(2): 96-115.
2.	Raab SS, Vrbin CM, Grzybicki DM, et al. Errors in thyroid gland fine-needle aspiration. Am J Clin Pathol, 2006, 125(6): 873-882.
3.	Paja M, Del Cura JL, Zabala R, et al. Core-needle biopsy in thyroid nodules: performance, accuracy, and complications. Eur Radiol, 2019, 29(9): 4889-4896.
4.	Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
5.	Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
6.	Jun P, Chow LC, Jeffrey RB. The sonographic features of papillary thyroid carcinomas: pictorial essay. Ultrasound Q, 2005, 21(1): 39-45.
7.	张坤, 姚瑶, 瞿国峰, 等. 超声引导下粗针穿刺活检在甲状腺结节鉴别诊断中的应用. 中华内分泌外科杂志, 2017, 11(4): 311-315.
8.	姜越, 龚建安, 邓博, 等. 彩超引导粗针穿刺活检对比细针吸取诊断甲状腺结节的应用价值. 海南医学院学报, 2014, 20(5): 667-669.
9.	段宝全, 胡亚飞. 超声下粗针、细针穿刺活检对10~15 mm甲状腺结节良恶性的诊断价值比较. 中国数字医学, 2019, 14(9): 59-61.
10.	吴杭, 陈宇, 向彦霖, 等. 超声引导粗针活检在诊断甲状腺结节中的应用价值. 西南军医, 2014, 16(5): 506-508.
11.	赵军凤, 钱林学, 史宪全, 等. 超声引导下粗针及细针穿刺活检甲状腺结节术后出血比较. 中国医学装备, 2016, 13(12): 33-37.
12.	汤四新, 张迅, 乐坚, 等. 超声引导下甲状腺结节活检3种方法的对比研究. 肿瘤影像学, 2016, 25(3): 263-266.
13.	李霞, 肖迎聪. 超声引导下甲状腺结节细针穿刺细胞学与粗针穿刺组织学检查的对比研究. 肿瘤防治研究, 2020, 47(9): 680-683.
14.	何俊峰, 闫国珍, 刘扬, 等. 甲状腺微小癌超声引导下细针穿刺细胞学与粗针穿刺组织学检查的临床对比研究. 中国超声医学杂志, 2018, 34(3): 211-213.
15.	杜轲锋. 超声引导下粗针及细针穿刺活检甲状腺结节术后出血比较. 中国全科医学, 2018, 21(z1): 230-232.
16.	Chen BT, Jain AB, Dagis A, et al. Comparison of the efficacy and safety of ultrasound-guided core needle biopsy versus fine-needle aspiration for evaluating thyroid nodules. Endocr Pract, 2015, 21(2): 128-135.
17.	Liu Q, Castelli M, Gattuso P, et al. Simultaneous fine-needle aspiration and core-needle biopsy of thyroid nodules. Am Surg, 1995, 61(7): 628-632, 632-633.
18.	Jin Kim H, Koon Kim Y, Hoon Moon J, et al. Thyroid core needle biopsy: patients’ pain and satisfaction compared to fine needle aspiration. Endocrine, 2019, 65(2): 365-370.
19.	Lee HJ, Kim YJ, Han HY, et al. Ultrasound-guided needle biopsy of large thyroid nodules: Core needle biopsy yields more reliable results than fine needle aspiration. J Clin Ultrasound, 2019, 47(5): 255-260.
20.	Jeong EJ, Chung SR, Baek JH, et al. A comparison of ultrasound-guided fine needle aspiration versus core needle biopsy for thyroid nodules: pain, tolerability, and complications. Endocrinol Metab (Seoul), 2018, 33(1): 114-120.
21.	Jung SJ, Kim DW, Baek HJ. Comparison study of the adequacy and pain scale of ultrasound-guided fine-needle aspiration of solid thyroid nodules with a 21- or 23-gauge needle for liquid-based cytology: a single-center study. Endocr Pathol, 2018, 29(1): 30-34.
22.	Karstrup S, Balslev E, Juul N, et al. US-guided fine needle aspiration versus coarse needle biopsy of thyroid nodules. Eur J Ultrasound, 2001, 13(1): 1-5.
23.	Renshaw AA, Pinnar N. Comparison of thyroid fine-needle aspiration and core needle biopsy. Am J Clin Pathol, 2007, 128(3): 370-374.
24.	Na DG, Kim JH, Sung JY, et al. Core-needle biopsy is more useful than repeat fine-needle aspiration in thyroid nodules read as nondiagnostic or atypia of undetermined significance by the Bethesda system for reporting thyroid cytopathology. Thyroid, 2012, 22(5): 468-475.
25.	Sung JY, Na DG, Kim KS, et al. Diagnostic accuracy of fine-needle aspiration versus core-needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort. Eur Radiol, 2012, 22(7): 1564-1572.
26.	Hakala T, Kholová I, Sand J, et al. A core needle biopsy provides more malignancy-specific results than fine-needle aspiration biopsy in thyroid nodules suspicious for malignancy. J Clin Pathol, 2013, 66(12): 1046-1050.
27.	Choi SH, Baek JH, Ha EJ, et al. Diagnosis of metastasis to the thyroid gland: comparison of core-needle biopsy and fine-needle aspiration. Otolaryngol Head Neck Surg, 2016, 154(4): 618-625.
28.	Ahn SH, Park SY, Choi SI. Comparison of consecutive results from fine needle aspiration and core needle biopsy in thyroid nodules. Endocr Pathol, 2017, 28(4): 332-338.
29.	Suh CH, Baek JH, Choi YJ, et al. Efficacy and safety of core-needle biopsy in initially detected thyroid nodules via propensity score analysis. Sci Rep, 2017, 7(1): 8242.
30.	Hong MJ, Na DG, Kim SJ, et al. Role of core needle biopsy as a first-line diagnostic tool for thyroid nodules: a retrospective cohort study. Ultrasonography, 2018, 37(3): 244-253.
31.	Yi KS, Kim JH, Na DG, et al. Usefulness of core needle biopsy for thyroid nodules with macrocalcifications: comparison with fine-needle aspiration. Thyroid, 2015, 25(6): 657-664.
32.	Ha EJ, Baek JH, Lee JH, et al. Complications following US-guided core-needle biopsy for thyroid lesions: a retrospective study of6,169 consecutive patients with6, 687 thyroid nodules. Eur Radiol, 2017, 27(3): 1186-1194.
33.	程莹, 邢军, 艾智华, 等. 3种不同直径穿刺针甲状腺活检时患者疼痛程度调查. 四川医学, 2014, 35(3): 312-314.
34.	Carpi A, Rossi G, Nicolini A, et al. Does large needle aspiration biopsy add pain to the thyroid nodule evaluation? PLoS One, 2013, 8(3): e58016.
35.	Nasrollah N, Trimboli P, Rossi F, et al. Patient’s comfort with and tolerability of thyroid core needle biopsy. Endocrine, 2014, 45(1): 79-83.

1. 中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中华核医学与分子影像杂志, 2013, 33(2): 96-115.
2. Raab SS, Vrbin CM, Grzybicki DM, et al. Errors in thyroid gland fine-needle aspiration. Am J Clin Pathol, 2006, 125(6): 873-882.
3. Paja M, Del Cura JL, Zabala R, et al. Core-needle biopsy in thyroid nodules: performance, accuracy, and complications. Eur Radiol, 2019, 29(9): 4889-4896.
4. Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
5. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
6. Jun P, Chow LC, Jeffrey RB. The sonographic features of papillary thyroid carcinomas: pictorial essay. Ultrasound Q, 2005, 21(1): 39-45.
7. 张坤, 姚瑶, 瞿国峰, 等. 超声引导下粗针穿刺活检在甲状腺结节鉴别诊断中的应用. 中华内分泌外科杂志, 2017, 11(4): 311-315.
8. 姜越, 龚建安, 邓博, 等. 彩超引导粗针穿刺活检对比细针吸取诊断甲状腺结节的应用价值. 海南医学院学报, 2014, 20(5): 667-669.
9. 段宝全, 胡亚飞. 超声下粗针、细针穿刺活检对10~15 mm甲状腺结节良恶性的诊断价值比较. 中国数字医学, 2019, 14(9): 59-61.
10. 吴杭, 陈宇, 向彦霖, 等. 超声引导粗针活检在诊断甲状腺结节中的应用价值. 西南军医, 2014, 16(5): 506-508.
11. 赵军凤, 钱林学, 史宪全, 等. 超声引导下粗针及细针穿刺活检甲状腺结节术后出血比较. 中国医学装备, 2016, 13(12): 33-37.
12. 汤四新, 张迅, 乐坚, 等. 超声引导下甲状腺结节活检3种方法的对比研究. 肿瘤影像学, 2016, 25(3): 263-266.
13. 李霞, 肖迎聪. 超声引导下甲状腺结节细针穿刺细胞学与粗针穿刺组织学检查的对比研究. 肿瘤防治研究, 2020, 47(9): 680-683.
14. 何俊峰, 闫国珍, 刘扬, 等. 甲状腺微小癌超声引导下细针穿刺细胞学与粗针穿刺组织学检查的临床对比研究. 中国超声医学杂志, 2018, 34(3): 211-213.
15. 杜轲锋. 超声引导下粗针及细针穿刺活检甲状腺结节术后出血比较. 中国全科医学, 2018, 21(z1): 230-232.
16. Chen BT, Jain AB, Dagis A, et al. Comparison of the efficacy and safety of ultrasound-guided core needle biopsy versus fine-needle aspiration for evaluating thyroid nodules. Endocr Pract, 2015, 21(2): 128-135.
17. Liu Q, Castelli M, Gattuso P, et al. Simultaneous fine-needle aspiration and core-needle biopsy of thyroid nodules. Am Surg, 1995, 61(7): 628-632, 632-633.
18. Jin Kim H, Koon Kim Y, Hoon Moon J, et al. Thyroid core needle biopsy: patients’ pain and satisfaction compared to fine needle aspiration. Endocrine, 2019, 65(2): 365-370.
19. Lee HJ, Kim YJ, Han HY, et al. Ultrasound-guided needle biopsy of large thyroid nodules: Core needle biopsy yields more reliable results than fine needle aspiration. J Clin Ultrasound, 2019, 47(5): 255-260.
20. Jeong EJ, Chung SR, Baek JH, et al. A comparison of ultrasound-guided fine needle aspiration versus core needle biopsy for thyroid nodules: pain, tolerability, and complications. Endocrinol Metab (Seoul), 2018, 33(1): 114-120.
21. Jung SJ, Kim DW, Baek HJ. Comparison study of the adequacy and pain scale of ultrasound-guided fine-needle aspiration of solid thyroid nodules with a 21- or 23-gauge needle for liquid-based cytology: a single-center study. Endocr Pathol, 2018, 29(1): 30-34.
22. Karstrup S, Balslev E, Juul N, et al. US-guided fine needle aspiration versus coarse needle biopsy of thyroid nodules. Eur J Ultrasound, 2001, 13(1): 1-5.
23. Renshaw AA, Pinnar N. Comparison of thyroid fine-needle aspiration and core needle biopsy. Am J Clin Pathol, 2007, 128(3): 370-374.
24. Na DG, Kim JH, Sung JY, et al. Core-needle biopsy is more useful than repeat fine-needle aspiration in thyroid nodules read as nondiagnostic or atypia of undetermined significance by the Bethesda system for reporting thyroid cytopathology. Thyroid, 2012, 22(5): 468-475.
25. Sung JY, Na DG, Kim KS, et al. Diagnostic accuracy of fine-needle aspiration versus core-needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort. Eur Radiol, 2012, 22(7): 1564-1572.
26. Hakala T, Kholová I, Sand J, et al. A core needle biopsy provides more malignancy-specific results than fine-needle aspiration biopsy in thyroid nodules suspicious for malignancy. J Clin Pathol, 2013, 66(12): 1046-1050.
27. Choi SH, Baek JH, Ha EJ, et al. Diagnosis of metastasis to the thyroid gland: comparison of core-needle biopsy and fine-needle aspiration. Otolaryngol Head Neck Surg, 2016, 154(4): 618-625.
28. Ahn SH, Park SY, Choi SI. Comparison of consecutive results from fine needle aspiration and core needle biopsy in thyroid nodules. Endocr Pathol, 2017, 28(4): 332-338.
29. Suh CH, Baek JH, Choi YJ, et al. Efficacy and safety of core-needle biopsy in initially detected thyroid nodules via propensity score analysis. Sci Rep, 2017, 7(1): 8242.
30. Hong MJ, Na DG, Kim SJ, et al. Role of core needle biopsy as a first-line diagnostic tool for thyroid nodules: a retrospective cohort study. Ultrasonography, 2018, 37(3): 244-253.
31. Yi KS, Kim JH, Na DG, et al. Usefulness of core needle biopsy for thyroid nodules with macrocalcifications: comparison with fine-needle aspiration. Thyroid, 2015, 25(6): 657-664.
32. Ha EJ, Baek JH, Lee JH, et al. Complications following US-guided core-needle biopsy for thyroid lesions: a retrospective study of6,169 consecutive patients with6, 687 thyroid nodules. Eur Radiol, 2017, 27(3): 1186-1194.
33. 程莹, 邢军, 艾智华, 等. 3种不同直径穿刺针甲状腺活检时患者疼痛程度调查. 四川医学, 2014, 35(3): 312-314.
34. Carpi A, Rossi G, Nicolini A, et al. Does large needle aspiration biopsy add pain to the thyroid nodule evaluation? PLoS One, 2013, 8(3): e58016.
35. Nasrollah N, Trimboli P, Rossi F, et al. Patient’s comfort with and tolerability of thyroid core needle biopsy. Endocrine, 2014, 45(1): 79-83.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of diagnostic accuracy, sampling satisfaction, and incidence of complications between ultrasound-guided core needle biopsy and fine needle aspiration biopsy of thyroid nodules: a meta-analysis

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