The role of core needle biopsy in the diagnosis of initially detected thyroid nodules: a systematic review and meta-analysis.

OBJECTIVES: To systematically review the published literature and evaluate the efficacy and safety of core needle biopsy (CNB) for initially detected thyroid nodules.

METHODS: The Ovid-MEDLINE and Embase databases were searched for studies evaluating CNB for the diagnosis of initially detected thyroid nodules. A meta-analysis was performed to evaluate non-diagnostic results, inconclusive results and diagnostic accuracy for a diagnosis of malignancy with CNB. To overcome heterogeneity, multiple subgroup analyses were performed. The complication rate was also evaluated.

RESULTS: Thirteen eligible studies, which included a total sample size of 9,166 patients with 13,585 nodules, were included. The pooled proportions were 3.5% (95% CI 2.4-5.1) for non-diagnostic results and 13.8% (95% CI 9.1-20.3) for inconclusive results. Considerable heterogeneity was observed among the studies in terms of the pooled proportions for CNB (I2 =92.9%, 97%). With regard to the diagnostic performance for malignancy, the sensitivity was 80% (95% CI 75-85) and the specificity was 100% (95% CI 93-100). Only two major complications of CNB were observed.

CONCLUSIONS: CNB demonstrates a low non-diagnostic result rate and high diagnostic accuracy for initially detected thyroid nodules and a low major complication rate. These findings indicate that CNB may be a feasible diagnostic tool for patients with initially detected thyroid nodules.

KEY POINTS: CNB demonstrates high diagnostic accuracy for initially detected thyroid nodules. CNB demonstrates a low major complication rate. CNB may be a feasible diagnostic tool for patients with initially detected thyroid nodules.