Effectiveness of core needle biopsy in the diagnosis of thyroid lymphoma and anaplastic thyroid carcinoma : A systematic review and meta-analysis

Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven ,Leuven ,Belgium
Vander Poorten, Vincent;
Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven ,Leuven ,Belgium
Goedseels, Nathan;
Department of Pathology, Liverpool Clinical Laboratories and School of Dentistry, University of Liverpool ,Liverpool ,United Kingdom
Triantafyllou, Asterios;
Department of Surgery, School of Medicine, Universidad de Antioquia-Ips Universitaria ,Medellín ,Colombia
Sanabria, Alvaro;
Department of Oncology, Section General Medical Oncology, KU Leuven ,Leuven ,Belgium
Clement, Paul M.;
Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, affiliated with Ben Gurion University of the Negev ,Be’er Sheva ,Israel
Cohen, Oded;
Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora ,Zielona Góra ,Poland
Golusinski, Pawel;
Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital ,Jena ,Germany
Guntinas-Lichius, Orlando;
Department of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili, University of Brescia ,Brescia ,Italy
Piazza, Cesare;
Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University ,Boston, MA ,United States
Randolph, Gregory W.;
University of Udine School of Medicine ,Udine ,Italy
Rinaldo, Alessandra;
Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University ,Safed ,Israel
Ronen, Ohad;
Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center ,Houston, TX ,United States
Cabanillas, Maria E.;
Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center ,New York, NY ,United States
Shaha, Ashok R.;
Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University ,Atlanta, GA ,United States
Teng, Yong;
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine ,Baltimore, Maryland ,United States
Tufano, Ralph P.;
Department of Pathology, University of Texas MD Anderson Cancer Center ,Houston, TX ,United States
Williams, Michelle D.;
Department of Head & Neck Surgery, MD Anderson Cancer Center ,Houston, TX ,United States
Zafereo, Mark;
International Head and Neck Scientific Group ,Padua ,Italy
Ferlito, Alfio

Background Both anaplastic thyroid carcinoma (ATC) and thyroid lymphoma (TL) clinically present as rapidly enlarging neck masses. Unfortunately, in this situation, like in any other thyroid swelling, a routine fine-needle aspiration (FNA) cytology is the first and only diagnostic test performed at the initial contact in the average thyroid practice. FNA, however, has a low sensitivity in diagnosing ATC and TL, and by the time the often “inconclusive” result is known, precious time has evolved, before going for core-needle biopsy (CNB) or incisional biopsy (IB) as the natural next diagnostic steps.

Objectives To determine the diagnostic value of CNB in the clinical setting of a rapidly enlarging thyroid mass, via a systematic review and meta-analysis of the available data on CNB reliability in the differential diagnosis of ATC and TL.

Methods A PubMed, Embase and Web of Science database search was performed on June 23th 2021. Population of interest comprised patients who underwent CNB for clinical or ultrasonographical suspicion of ATC or TL, patients with a final diagnosis of ATC or TL after CNB, or after IB following CNB.

Results From a total of 17 studies, 166 patients were included. One hundred and thirty-six were diagnosed as TL and 14 as ATC following CNB. CNB, with a sensitivity and positive predictive value of 94,3% and 100% for TL and 80,1% and 100% for ATC respectively, proved to be superior to FNA (reported sensitivity for TL of 48% and for ATC of 61%). Furthermore, the need for additional diagnostic surgery after CNB was only 6.2% for TL and 17.6% for ATC.

Conclusions Immediately performing CNB for a suspected diagnosis of ATC and TL in a rapidly enlarging thyroid mass is more appropriate and straightforward than a stepped diagnostic pathway using FNA first and awaiting the result before doing CNB.


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License Holder: Copyright © 2022 Vander Poorten, Goedseels, Triantafyllou, Sanabria, Clement, Cohen, Golusinski, Guntinas-Lichius, Piazza, Randolph, Rinaldo, Ronen, Cabanillas, Shaha, Teng, Tufano, Williams, Zafereo and Ferlito

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