Journal List > Int J Thyroidol > v.9(1) > 1082758

Int J Thyroidol. 2016 May;9(1):9-14. Korean.
Published online May 31, 2016.
Copyright © 2016. the Korean Thyroid Association. All rights reserved.
Thyroid Nodules with Nondiagnostic FNA Results: Role of Core Needle Biopsy
Jung Hwan Baek
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence: Jung Hwan Baek, MD, PhD, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 05505, Korea. Tel: 82-2-3010-4348, Fax: 82-2-476-0090, Email:
Received June 17, 2015; Revised April 04, 2016; Accepted April 19, 2016.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Fine needle aspiration (FNA) has been a standard technique for diagnosing thyroid cancer; however nondiagnostic FNA result is a major limitation of FNA. To overcome this limitation, core needle biopsy (CNB) has been applied to nodules with previous nondiagnostic FNA results. In this review article, we will review the role of CNB for thyroid nodules with previous nondiagnostic FNA results focusing on the efficacy and safety.

Keywords: Core needle biopsy; Fine needle aspiration; Thyroid nodule; Ultrasonography; Nondiagnostic result


Fig. 1
US images in a 56-year-old woman with calcified thyroid nodules show core-needle biopsy technique. (A) Nodule size (dotted line) was measured and (B) the stylet (arrows) was fired first. The mass is located inside the specimen notch (notch in the stylet. and (C) cutting cannula (arrows) of the needle was sequentially fired (notch in the stylet). RMP: right mid-pole.
Click for larger image

1. Pitman MB, Abele J, Ali SZ, Duick D, Elsheikh TM, Jeffrey RB, et al. Techniques for thyroid FNA: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 2008;36(6):407–424.
2. Silverman JF, West RL, Finley JL, Larkin EW, Park HK, Swanson MS, et al. Fine-needle aspiration versus large-needle biopsy or cutting biopsy in evaluation of thyroid nodules. Diagn Cytopathol 1986;2(1):25–30.
3. Wang C, Vickery AL Jr, Maloof F. Needle biopsy of the thyroid. Surg Gynecol Obstet 1976;143(3):365–368.
4. Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedus L, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract 2010;16 Suppl 1:1–43.
5. Tee YY, Lowe AJ, Brand CA, Judson RT. Fine-needle aspiration may miss a third of all malignancy in palpable thyroid nodules: a comprehensive literature review. Ann Surg 2007;246(5):714–720.
6. Wang CC, Friedman L, Kennedy GC, Wang H, Kebebew E, Steward DL, et al. A large multicenter correlation study of thyroid nodule cytopathology and histopathology. Thyroid 2011;21(3):243–251.
7. Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer 2009;117(3):195–202.
8. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer 2007;111(5):306–315.
9. Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer 2007;111(6):508–516.
10. Taki S, Kakuda K, Kakuma K, Annen Y, Katada S, Yamashita R, et al. Thyroid nodules: evaluation with US-guided core biopsy with an automated biopsy gun. Radiology 1997;202(3):874–877.
11. Liu Q, Castelli M, Gattuso P, Prinz RA. Simultaneous fine-needle aspiration and core-needle biopsy of thyroid nodules. Am Surg 1995;61(7):628–632.
discussion 632-3.
12. Quinn SF, Nelson HA, Demlow TA. Thyroid biopsies: fine-needle aspiration biopsy versus spring-activated core biopsy needle in 102 patients. J Vasc Interv Radiol 1994;5(4):619–623.
13. Na DG, Kim JH, Sung JY, Baek JH, Jung KC, Lee H, et al. Core-needle biopsy is more useful than repeat fine-needle aspiration in thyroid nodules read as nondiagnostic or atypia of undetermined significance by the Bethesda system for reporting thyroid cytopathology. Thyroid 2012;22(5):468–475.
14. Sung JY, Na DG, Kim KS, Yoo H, Lee H, Kim JH, et al. Diagnostic accuracy of fine-needle aspiration versus core-needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort. Eur Radiol 2012;22(7):1564–1572.
15. Yeon JS, Baek JH, Lim HK, Ha EJ, Kim JK, Song DE, et al. Thyroid nodules with initially nondiagnostic cytologic results: the role of core-needle biopsy. Radiology 2013;268(1):274–280.
16. Baek JH, Na DG, Lee JH, Jung SL, Kim JH, Sung JY, et al. Core needle biopsy of thyroid nodules: consensus statement and recommendations. J Korean Soc Ultrasound Med 2013;32(2):95–102.
17. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014;81 Suppl 1:1–122.
18. Tuttle RM, Haddad RI, Ball DW, Byrd D, Dickson P, Duh QY, et al. Thyroid carcinoma, version 2.2014. J Natl Compr Canc Netw 2014;12(12):1671–1680.
quiz 80.
19. Yi KH, Park YJ, Koong SS, Kim JH, Na GD, Ryu JS, et al. Revised Korean Thyroid Association management guidelines for patients with thyroid nodules and thyroid cancer. J Korean Thyroid Assoc 2010;3(2):65–96.
20. Park KT, Ahn SH, Mo JH, Park YJ, Park do J, Choi SI, et al. Role of core needle biopsy and ultrasonographic finding in management of indeterminate thyroid nodules. Head Neck 2011;33(2):160–165.
21. Samir AE, Vij A, Seale MK, Desai G, Halpern E, Faquin WC, et al. Ultrasound-guided percutaneous thyroid nodule core biopsy: clinical utility in patients with prior nondiagnostic fine-needle aspirate. Thyroid 2012;22(5):461–467.
22. Alexander EK, Heering JP, Benson CB, Frates MC, Doubilet PM, Cibas ES, et al. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab 2002;87(11):4924–4927.
23. Choi SH, Baek JH, Lee JH, Choi YJ, Hong MJ, Song DE, et al. Thyroid nodules with initially non-diagnostic, fine-needle aspiration results: comparison of core-needle biopsy and repeated fine-needle aspiration. Eur Radiol 2014;24(11):2819–2826.
24. Lee SH, Kim MH, Bae JS, Lim DJ, Jung SL, Jung CK. Clinical outcomes in patients with non-diagnostic thyroid fine needle aspiration cytology: usefulness of the thyroid core needle biopsy. Ann Surg Oncol 2014;21(6):1870–1877.
25. Ha EJ, Baek JH, Lee JH, Kim JK, Kim JK, Lim HK, et al. Core needle biopsy can minimise the non-diagnostic results and need for diagnostic surgery in patients with calcified thyroid nodules. Eur Radiol 2014;24(6):1403–1409.
26. Screaton NJ, Berman LH, Grant JW. US-guided core-needle biopsy of the thyroid gland. Radiology 2003;226(3):827–832.
27. Khoo TK, Baker CH, Hallanger-Johnson J, Tom AM, Grant CS, Reading CC, et al. Comparison of ultrasound-guided fine-needle aspiration biopsy with core-needle biopsy in the evaluation of thyroid nodules. Endocr Pract 2008;14(4):426–431.
28. Ha EJ, Baek JH, Lee JH, Song DE, Kim JK, Shong YK, et al. Sonographically suspicious thyroid nodules with initially benign cytologic results: the role of a core needle biopsy. Thyroid 2013;23(6):703–708.
29. Harvey JN, Parker D, De P, Shrimali RK, Otter M. Sonographically guided core biopsy in the assessment of thyroid nodules. J Clin Ultrasound 2005;33(2):57–62.
30. Zhang M, Zhang Y, Fu S, Lv F, Tang J. Thyroid nodules with suspicious ultrasound findings: the role of ultrasound-guided core needle biopsy. Clin Imaging 2014;38(4):434–438.
31. Nasrollah N, Trimboli P, Rossi F, Amendola S, Guidobaldi L, Ventura C, et al. Patient's comfort with and tolerability of thyroid core needle biopsy. Endocrine 2014;45(1):79–83.
32. Stangierski A, Wolinski K, Martin K, Leitgeber O, Ruchala M. Core needle biopsy of thyroid nodules - evaluation of diagnostic utility and pain experience. Neuro Endocrinol Lett 2013;34(8):798–801.
33. Carpi A, Rossi G, Nicolini A, Iervasi G, Russo M, Mechanick J. Does large needle aspiration biopsy add pain to the thyroid nodule evaluation? PLoS One 2013;8(3):e58016.