Fine-Needle Biopsy: A reliable test for thyroid cancer diagnosis

Madison: According to a research that was published in JAMA Surgery, Fine-Needle Biopsy is still a promising method for detecting thyroid cancer.

"Thyroid FNB reliability over time really hasn't altered much," the authors quoted.

Traditional thyroid nodule screening criteria are ineffective at detecting the small percentage of malignant neoplasms. The primary function of a fine needle biopsy is to distinguish between a benign and cancerous thyroid nodule. It has a significant impact on the choice of treatment. In the 1970s, FNB developed into a significant component of thyroid nodule evaluation. It is unclear how the FNB's diagnostic precision has altered over time.

The researchers sought to determine the accuracy of thyroid FNB for the diagnosis of cancer in adults with a newly diagnosed thyroid nodule and to define changes in accuracy with time, for which a systematic review and meta-analysis were conducted.

Employing search terms relevant to FNB accuracy in the thyroid, PubMed, SCOPUS, and the Cochrane Central Register of Controlled Trials were explored from 1975 to 2020.

For this investigation, randomized trials of adult patients undergoing thyroid FNB with sample sizes of 20 or more and using surgical histopathology or clinical follow-up as a reference standard were included. They omitted studies that only looked at patients with known thyroid illness or those concentrated on the precision of innovative adjuncts such as molecular diagnostics. Each article was reviewed by two researchers, who also reached consensus on disagreements. Out of 1023 studies, 36 met the criterion for selection. Data abstraction and evaluation of data validity and quality were done in accordance with the MOOSE guidelines. Utilizing a common form, study team extracted the data. Trials were categorized by median data collection year into epochs (1975 to 1990, 1990 to 2000, 2000 to 2010, and 2010 to 2020). Using a bivariate mixed-effects model, data were combined.

The main result was how accurately FNB diagnosed cancer. Prior to data collection, a hypothesis was made that stated accuracy would rise over time.

Key findings of the research:

• FNB had a positive likelihood ratio of 3.0 (95% CI, 2.3-4.1), a negative likelihood ratio of 0.2 (95% CI, 0.2-0.3), a sensitivity of 85.6% (95% CI, 79.9-89.5), and a specificity of 71.4% (95% CI, 61.1-79.8).
• The receiver operating characteristic curve's area under it was 86.1%.
• Epoch and accuracy were not significantly correlated.
• The reported heterogeneity could not be explained by any of the available factors.

The authors mentioned that significant advancements in technique, preparation, and interpretation "may have occurred too heterogeneously to capture a consistent increase through time."

They came to the conclusion that thyroid FNB's diagnostic accuracies had not changed noticeably over time.

REFERENCE

Hsiao V, Massoud E, Jensen C, et al. Diagnostic Accuracy of Fine-Needle Biopsy in the Detection of Thyroid Malignancy: A Systematic Review and Meta-analysis. JAMA Surg. Published online October 12, 2022. doi:10.1001/jamasurg.2022.4989