ORIGINAL RESEARCH article
Front. Oncol.
Sec. Head and Neck Cancer
Core Needle Biopsy as a First-Line Diagnostic Tool for Selected Thyroid Nodules: A Real-World Evaluation of Diagnostic Performance and Safety
Provisionally accepted
- 1Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- 2Tianjin Cancer Hospital Airport Hospital, Tianjin, China
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Purpose To evaluate the diagnostic performance and safety of core needle biopsy (CNB) as a first-line diagnostic tool in selected thyroid nodules with suspicious imaging features or other high-risk characteristics in a real-world setting. Methods The protocol of this observational study was approved by the Review Board of Tianjin Medical University Cancer Institute and Hospital. All the medical records of patients who underwent ultrasound (US)-guided CNB of thyroid nodules were searched from January 1, 2022 to April 30, 2023. US-guided CNB was performed using a disposable 18-gauge needle, and the pathological results of CNB were divided into six categories: nondiagnostic, benign, indeterminate, follicular neoplasms (FN) or suspected follicular neoplasms (SFN), suspicion of malignancy, and malignancy. The diagnostic performance and complications of CNB and the risk factors associated with inconclusive results were assessed. Results A total of 286 patients with 316 nodules were included in the study. Of 199 cases of malignant nodules, 72 cases were confirmed by surgery after CNB and 127 cases were managed as malignant based on definitive CNB findings in conjunction with clinical and imaging correlation, without surgical confirmation. Among 78 benign nodules, 8 cases were confirmed by surgery, 50 cases were confirmed by CNB plus contrast-enhanced ultrasound (CEUS), and 20 cases were confirmed by CNB with no change in follow-up for more than 1 year. The non-diagnostic rate was 1.9%, and the inconclusive rate was 10.4%. The diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value of CNB were 98.2%,100.0%, 93.6%, 97.5%, 100.0%, respectively. And the unnecessary surgery rate was 6.3%. Conclusion CNB is an effective diagnostic tool for thyroid nodules, demonstrating high diagnostic accuracy and a low rate of non-diagnostic results. It may serve as a viable alternative or complementary first-line diagnostic option in selected nodules, particularly those with suspicious ultrasound features or larger size, by providing reliable histological architectural assessment.
Keywords: contrast-enhanced ultrasound, Core needle biopsy, Diagnostic performance, fine-needle aspiration, Safety, Thyroid Nodule, Ultrasonography
Received: 17 Sep 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 Li, Pan, Ou, Gao, Gao, Liu, Li, Xu and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yong Xu
Wengui Xu
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