Role Of Core Needle Biopsy in The Diagnosis of Thyroid Nodules: A Systematic Literature Review

Abstract

IMPORTANCE With the rapidly increasing number of nodular goiter cases, advances are being made in diagnostic modalities. One of these is the Core Needle Biopsy (CNB) which gives a larger tissue specimen for diagnosis. This technique has its merits as well as demerits. The current article elaborates the characteristics of Core needle biopsy in comparison with the gold standard Fine Needle Aspiration Cytology (FNAC), as a diagnostic tool for thyroid nodules.

OBJECTIVE: This systematic review article aims to find out the role of Core needle biopsy in the diagnosis of thyroid nodules, both as a first-line technique and as a complementary method to fine-needle aspiration cytology (FNAC).

METHODS: A systematic review of full-text articles from the last 5 years, retrieved from PubMed, ProQuest, and Google Scholar, was performed. Out of 1032 articles retrieved, a detailed thematic analysis of records was used for screening out 12 relevant articles for final review.

RESULTS: It is argued that core needle or Tru-Cut biopsy (CNB/TCB) leads to a lower proportion of undiagnosed biopsy results because of adequate tissue sampling, at the cost of increased diagnoses of atypia of undetermined significance, and hence, leading to more diagnostic surgeries. Therefore, FNAC remains the first-line investigation in the majority of medical centers all over the world due to its higher negative predictive value, ease of use, lower pooled proportion of serious complications, and equal diagnostic surgeries performed in comparison with CNB.

CONCLUSION:  CNB leads to a lower pooled population of nondiagnostic results as it provides a larger sample size with the availability of immunohistochemistry and histological architecture studies. Some disadvantages also need to be kept in mind such as the risk of more serious complications as it is a more invasive technique in comparison to FNAC.