Indications for Core Needle Biopsy in Low-Suspicion Thyroid Nodules on US.

Authors

Myoung Kyoung Kim, Jung Hee Shin, Haejung Kim, Soo Yeon Hahn

Published in

Journal of the Korean Society of Radiology. Volume 87. Issue 4. Pages 673-685. Epub Apr 17, 2026.

Abstract

This study aimed to identify the appropriate clinical indications for core needle biopsy (CNB) in low-suspicion nodules (Korean Thyroid Imaging Reporting and Data System category 3) by assessing the US features associated with CNB-based diagnoses of malignancy and surgically relevant disease.
Between January 2018 and December 2019, 910 thyroid nodules from 903 patients underwent US-guided CNB. Among these, 271 patients with low-suspicion thyroid nodules on US who later underwent surgery were included in this study. The nodules were dichotomized into two categories: malignancy (including low-suspicion neoplasms) and surgical disease (categorized as follicular neoplasm, suspicious for malignancy, or malignancy on CNB). Hypervascularity was defined as types 3 or 4.
The malignancy rate of resected low-suspicion nodules was found to be 36.5%. In low-suspicion nodules, a well-defined halo and hypervascularity were independent risk factors associated with malignancy (odds ratio = 2.06, 95% confidence interval [CI] = 1.11-3.83, p = 0.02 for well-defined halo; odds ratio = 3.54, 95% CI = 1.96-6.38, p < 0.01 for hypervascularity) and surgical disease (odds ratio = 4.96, 95% CI = 2.66-9.24, p < 0.01 for well-defined halo; odds ratio = 2.98, 95% CI = 1.96-6.38, p < 0.01 for hypervascularity). When the two features were combined, the diagnostic area under the receiver operating characteristic curve was 0.660 for malignancy and 0.709 for surgical disease.
Targeting low-suspicion thyroid nodules with a well-defined halo and hypervascularity observed on US may provide supplementary diagnostic value in identifying nodules associated with malignancy and surgical disease using CNB.

PMID:
42568825
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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