Comparison of core-needle biopsy and repeat fine-needle aspiration biopsy for thyroid nodules with initially inconclusive findings: a systematic review, diagnostic accuracy meta-analysis, and meta-regression.

INTRODUCTION

The rate of nondiagnostic and indeterminate cytology findings from fine-needle aspiration biopsy (FNAB) is quite high, resulting in repeated puncture and unnecessary surgery. The primary objective of this investigation is to compare diagnostic accuracy of core-needle biopsy (CNB) with repeat FNAB for thyroid nodules with initially inconclusive (nondiagnostic and/or atypia of undetermined significance) FNAB results.

MATERIALS AND

METHODS

A thorough search was performed on the Cochrane Library, Scopus, Europe PMC, and Medline databases until October 20th, 2024, employing a combination of pertinent keywords. This review incorporates literature that examines the comparison between CNB and repeat FNAB for thyroid nodule. Pooled odds ratio (OR) of nondiagnostic and inconclusive findings of CNB and repeat FNAB were calculated. A meta-analysis was conducted to assess the diagnostic accuracy of both biopsy methods for malignancy diagnosis utilizing a bivariate random-effects model.

RESULTS

A total of 9 studies were incorporated. The results of our meta-analysis indicated lower rate of nondiagnostic (OR 0.12; 95% confidence interval [CI]: 0.06-0.23, P < 0.00001), atypia of undetermined significance (OR 0.34; 95%CI: 0.21-0.56, P < 0.0001), and inconclusive (OR 0.12; 95%CI: 0.07-0.22, P < 0.00001) findings from CNB compared to repeat FNAB. CNB also exhibited markedly superior cumulative sensitivity estimates (75.1%) compared to repeat FNAB (56.5%), however cumulative specificity did not show a significant difference between CNB (99.9%) and repeat FNAB (99.7%). No patients who received CNB or repeat FNAB encountered any major complications.

CONCLUSIONS

Our study suggests that CNB can be employed to diagnose thyroid nodules that were previously inconclusive on FNAB, rather than repeating the FNAB procedure.