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A core needle biopsy provides more malignancy-specific results than fine-needle aspiration biopsy in thyroid nodules suspicious for malignancy
  1. T Hakala1,2,
  2. I Kholová3,
  3. J Sand2,4,
  4. R Saaristo1,
  5. P Kellokumpu-Lehtinen2,5
  1. 1Department of Surgery, Tampere University Hospital, Tampere, Finland
  2. 2University of Tampere, School of Medicine, Tampere, Finland
  3. 3Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
  4. 4Division of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland
  5. 5Department of Oncology, Tampere University Hospital, Tampere, Finland
  1. Correspondence to Dr Tommi Hakala, Department of Surgery, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland; tommi.hakala{at}


Background and aims The most commonly used diagnostic method for the preoperative diagnosis of thyroid nodules is ultrasound-guided fine-needle aspiration biopsy (FNA), which often yields non-diagnostic or non-definitive results and seldom produces definite malignant diagnoses. To improve upon the malignancy-specific sensitivity, we tested core needle biopsies (CNBs) of thyroid lesions taken from surgical specimens.

Material and methods 52 consecutive patients with malignant or malignant-suspicious thyroid nodules were referred to Tampere University Hospital between May 2010 and December 2011. Preoperative FNAs were categorised as follicular neoplasm (48%), suspicion for malignancy (46%) or malignancy (6%). Intraoperative FNA and CNB samples were acquired from surgical specimens removed during surgery. The results of the needle biopsies were compared with the final pathological diagnosis.

Results CNBs had a high definitive sensitivity for malignancy (61%, CI 41% to 78%) whereas the definitive sensitivity for malignancy of FNAs was significantly lower (22%, CI 10% to 42%). CNB was not beneficial in the diagnosis of follicular thyroid lesions. When all suspected follicular tumours were excluded, the definitive sensitivity of CNB rose to 70% (CI 48% to 86%).

Conclusions CNB may be beneficial for the diagnosis of papillary thyroid carcinoma and other non-follicular thyroid lesions. CNB may be considered as an additional diagnostic procedure in cases with FNA suspicious for malignancy.


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