Objective: Anaplastic thyroid carcinoma (ATC) and primary thyroid lymphoma (PTL) are two highly aggressive malignancies of the thyroid, both leading to a rapidly enlarging neck mass. Fine-needle aspiration cytology (FNAC) is generally performed as the primary examination for diagnosis in thyroid pathology but shows low sensitivity in diagnosing ATC or PTL. Non-diagnostic FNACs are usually followed by core-needle biopsy (CNB) or diagnostic surgery. As sensitivities of up to 100% have been described, we investigate whether executing CNB primarily is more desirable than FNAC in the diagnosis of ATC and PTL. We want to determine the diagnostic value of CNB by combining all published data on the reliability of CNB in diagnosing ATC and PTL in a systematic review and meta-analysis.
Methods: A search was performed on June 23rd, 2021 on PubMed, EmBase, Web of Science and Cochrane. Population of interest were patients who underwent CNB due to clinical or ultrasonographical suspicious features of ATC or PTL or patients with final diagnosis of ATC or PTL after CNB or after surgery following CNB.
Results: A total of 166 patients were included of which 136 patients were diagnosed as PTL and 14 patients as ATC after CNB. CNB proves to be superior to FNAC with a sensitivity and PPV of respectively 93.8% and 100% for PTL and 82.4% and 100% for ATC. Furthermore, rate of diagnostic surgery after CNB was only 6.2% for PTL and 17.6% for ATC.
Conclusions: We conclude that CNB could be a more appropriate intervention for diagnosis of ATC and PTL than FNAC.
10 Sep 2022 - 13 Sep 2022