Thyroid Nodules and Cancer 101: What is Core Needle Biopsy CNB for Thyroid Nodules and Cancer?

Thyroid Nodules and Cancer 101: What is Core Needle Biopsy CNB for Thyroid Nodules and Cancer?

Thyroid Nodules and Cancer 101: What is Core Needle Biopsy CNB for Thyroid Nodules and Cancer?
Core Needle Biopsy Is Useful for Diagnosis
of Thyroid Nodules after Previous FNA
Biopsy was Nondiagnostic
Samir AE, Vij A, Seale MK, Desai G, Halpern E, Faquin WC, Parangi S, Hahn PF, Daniels GH
Photographs from Core Needle Biopsy of the Thyroid: 2016 Consensus
Statement and Recommendations from Korean Society
of Thyroid Radiology Korean J Radiol 2017;18(1):217-237 Dong Gyu Na, et al
img_1687
This is a CNB with a Stylet and notch (A)to cut the specimen and the Cutting Canula (B)
These have larger bore needles 18-21 than needed for FNA 25-27.
img_1690
The CNB is inserted into the nodule and the specimen notch is position to include a piece of the capsule.The cutting canula is then used to cut the specimen and send for pathology. This is not cytology but actual fragment of the thyroid nodule and capsule.
img_1692
 This is not cytology but actual fragment of the normal thyroid, nodule and capsule.This is an example of a microfollicular neoplasm.
2012 review of CNB in Clinical thyroidology
.
Ultrasound-guided percutaneous thyroid nodule core biopsy: clinical utility in patients with
prior nondiagnostic fine-needle aspirate
. Thyroid 2012;22:461-7
CLINICAL THYROIDOLOGY
ANALYSIS AND COMMENTARY
Core needle biopsy of palpable thyroid nodules
was performed in the 1950s and 1960s, usually
by trained thyroid surgeons, because of the fear of
bleeding complications if a large vessel was lacerated
(1). The procedure was not adopted by endocrinologists
and was fortunately supplanted by FNA
in the 1970s. Refinement of the needles to smaller
diameters and the use of ultrasound guidance has
now made CB more feasible. Potential advantages of
CB are that it can provide more tissue and preserve
the cellular architecture. Interventional radiologists
have the most experience with CB and performed the
procedure in this study. Aside from its technical difficulty
, CB has not been widely used because earlier
comparative studies of FNA and CB showed no diagnostic advantage for CB (2,3).
In the same issue of Thyroid, a paper from a group
in Korea compared the use of CB and FNA for evaluation of 149 nodules that were nondiagnostic or follicular lesion of undetermined significance (FLUS)
(4). They used an 18-gauge spring-activated needle
and lidocaine anesthesia. They reported that the diagnostic sensitivity of CB was higher than that of FNA in the FLUS category, but this was not statistically
significant in the 45 patients who had prior nondiagnostic FNA. They noted no major complications of CB, but there were perithyroidal hematomas in 3.6%
and mild transient parenchymal edema in 2.3%. They
concluded that CB is more useful than repeat FNA in
patients with inconclusive diagnostic results.
The pendulum seems to be swinging back to reconsideration of core biopsy for patients with inconclusive diagnostic results. However, the decision to use
CB must be based on multiple factors: the suspicion of
malignancy on ultrasound and other clinical features,
the availability of expertise in performing CB of
thyroid nodules, the need to discontinue anticoagulation,
and the potential benefit to the patient.
— Jerome M. Hershman, MD
CNB image of pathology of the core tissue seen is consistent with a papillary thyroid cancer
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