Core Needle Biopsy Is a More Conclusive Follow up Method Than Repeat Fine Needle Aspiration for Thyroid Nodules with Initially Inconclusive Results: A Systematic Review and Meta Analysis
Background: This study investigated the appropriate management of thyroid nodules with prior non diagnostic or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) through a systematic review and meta analysis. Methods: This study included 4,235 thyroid nodules from 26 eligible studies. We investigated the conclusive rate of follow up core needle biopsy (CNB) or repeat fine needle aspiration (rFNA) after initial fine needle aspiration (FNA) with non diagnostic or AUS/FLUS results. A diagnostic test accuracy (DTA) review was performed to determine the diagnostic role of the follow up CNB and to calculate the area under the curve (AUC) on the summary receiver operating characteristic (SROC) curve. Results: The conclusive rates of follow up CNB and rFNA after initial FNA were 0.879 (95% confidence interval [CI] 0.801 to 0.929) and 0.684 (95% CI, 0.627 to 0.736) respectively. In comparison of the odds ratios of CNB and rFNA, CNB had more frequent conclusive results than rFNA (odds ratio, 5.707; 95% CI, 2.530 to 12.875) Upon subgroup analysis, follow up CNB showed a higher conclusive rate than rFNA in both initial non diagnostic and AUS/FLUS subgroups. In DTA review of followup CNB, the pooled sensitivity and specificity were 0.94 (95% CI, 0.88 to 0.97) and 0.88 (95% CI, 0.84 to 0.91) respectively. The AUC for the SROC curve was 0.981, nearing 1. Conclusions: Our results show that CNB has a higher conclusive rate than rFNA when the initial FNA produced inconclusive results. Further prospective studies with more detailed criteria are necessary before follow up CNB can be applied in daily practice.
Journal of pathology and translational medicine