Comparison of core-needle biopsy and fine-needle aspiration in screening for thyroid malignancy: a systematic review and meta-analysis

Objective: Core-needle biopsy (C.N.B.) is a procedure that is usually performed after repeated non-diagnostic fine-needle aspiration (F.N.A.) or in combination with F.N.A. in the detection of thyroid malignancy. The purpose of this study was to: (1) compare the accuracy of C.N.B. and F.N.A. in the detection of thyroid malignancy; (2) evaluate the accuracy of C.N.B. in nodules with prior non-diagnostic F.N.A. results. Methods: Meta-analysis was performed with Comprehensive Meta-Analysis statistical software, version 2.0. A bivariate approach of hierarchical summary R.O.C. was performed using R software. Study quality was assessed with the Cochrane Risk of Bias Tool. Publication bias analysis was performed by funnel plot and Egger's test analysis. Results: The main results of our study are as follows. 1) Overall C.N.B. had fewer non-diagnostic results than F.N.A. (pooled O.R. = 4.93, 95% C.I.: 2.17-11.19). Pooled sensitivities and specificities of C.N.B. and F.N.A. did not differ significantly. (2) There was no significant difference in the rates of non-diagnostic results of first-line F.N.A. and C.N.B. (O.R. = 2.42, 95% C. I. 0.95-6.18). Pooled sensitivities and specificities did not differ significantly. C.N.B. yielded fewer non-diagnostic results compared to repeated F.N.A. (O.R. = 19.13, 95% C. I. 7.08-51.65) for thyroid cancers with prior non-diagnostic F.N.A. results. The A.U.C.s of the hierarchical summary R.O.C. (H.S.R.O.C.) were 0.669 for repeated F.N.A. and 0.984 for C.N.B. with separated confidence regions for sensitivity and false positive rate. Conclusion: C.N.B. has higher diagnostic accuracy than repeat F.N.A. for thyroid nodules with prior nondiagnostic F.N.A. results. There is no significant difference in the diagnostic performance of C.N.B. and F.N.A. as first-line diagnostic tools.