PROSPECTIVE COMPARISON OF FINE NEEDLE ASPIRATION CYTOLOGY AND CORE NEEDLE BIOPSY DIAGNOSTIC ACCURACY IN THYROID NODULE ASSESSMENT
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Keywords
Thyroid nodule, Fine needle aspiration cytology, Core needle biopsy, Diagnostic accuracy, Bethesda System
Abstract
Thyroid nodules are encountered frequently in clinical practice, with approximately 5% demonstrating malignant potential. Fine needle aspiration cytology and core needle biopsy are the primary tissue sampling techniques for thyroid nodule evaluation, yet their comparative diagnostic accuracy remains incompletely characterized, particularly in the Indian population.
Methods: A prospective comparative diagnostic study was conducted at Ventakeshwara Institute of Medical Sciences, Amroha, Uttar Pradesh over six months (July to December 2018). One hundred forty-eight consecutive patients with thyroid nodules underwent both ultrasound-guided FNAC and CNB of the same nodule. Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and nondiagnostic specimen rates were compared using McNemar's test. Final diagnosis was established through surgical histopathology or clinical and radiological follow-up.
Results: Core needle biopsy demonstrated significantly superior overall diagnostic accuracy (95.9%) compared to FNAC (85.1%, p=0.012). CNB exhibited higher sensitivity (94.6% versus 82.4%, p=0.018) and specificity (96.8% versus 88.2%, p=0.042). Core needle biopsy substantially reduced nondiagnostic specimens (2.7% versus 8.1%, p=0.045). Among 68 confirmed malignancies, CNB identified 64 cases while FNAC identified 56. Follicular carcinoma detection showed markedly superior CNB sensitivity (80%) compared to FNAC (30%). Mean procedure cost for CNB (INR 7,020) exceeded FNAC (INR 4,040), though accounting for reduced repeat procedures favored CNB cost-effectiveness.
Conclusion: Core needle biopsy provides superior diagnostic accuracy compared to FNAC, particularly for follicular lesions and ambiguous cases. CNB should be considered for initial diagnostic evaluation of radiologically suspicious thyroid nodules or as follow-up for indeterminate FNAC results.
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Dr Babu Lal Jain
Assistant Professor, Department of Pathology Venkateshwara Institute of Medical Sciences, Amroha, Uttar Pradesh,