Validity of core needle biopsy in diagnosing primary thyroid lymphoma: a systematic-review and meta-analysis
Main Article Content
Abstract
Background
Primary thyroid lymphoma (PTL) is a rare thyroid malignancy, accounting for less than 5% of thyroid malignancies. The prognosis of PTL depends on the histologic subtype and stage of disease at diagnosis, hence an effective diagnostic method is needed to ensure prompt treatments. Fine needle aspiration (FNA) is the first test for microscopic examination of a rapidly enlarging thyroid mass, but its limitations and low sensitivity have been observed. After the often “inconclusive” result is known, core-needle biopsy (CNB) should be performed as the natural next diagnostic step. This systematic review and meta-analysis aimed to evaluate the diagnostic value of core needle biopsy (CNB) in diagnosing PTL.
Methods
This systematic review and meta-analysis follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A PubMed and Embase database search was performed in August 2025. Populations included were patients with final diagnosis of PTL. Pooled sensitivity was calculated using a random-effects model.
Results
This systematic review and meta-analysis of 12 studies comprised a total of 1091 patients. Core needle biopsy proved to be highly effective, with a pooled sensitivity of 91.6% (95% CI: 82.1%–96.3%). The development of tumor-cell seeding following CNB has been a major concern, but this complication is extremely rare. Other potential complications include bleeding and infection.
Conclusion
Core needle biopsy demonstrates high diagnostic sensitivity and a favorable safety profile in diagnosing primary thyroid lymphoma, supporting its role as a valuable diagnostic modality, particularly when PTL is clinically suspected or FNA results are inconclusive.
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The journal allows the authors to hold the copyright without restrictions and allow the authors to retain publishing rights without restrictions.
How to Cite
References
1. Sharma A, Jasim S, Reading CC, et al. Clinical presentation and diagnostic challenges of thyroid lymphoma: a cohort study. Thyroid 2016;26:1061–7. doi: 10.1089/thy.2016.0095.
2. González-Sánchez C, Salvador-Egea MP, Glückmann-Maldonado E, et al. Diagnosis and treatment of primary thyroid lymphoma from a surgical perspective: a multi-institutional study. Langenbecks Arch Surg 2023;408:1-5. doi: 10.1007/s00423-023-02945-x.
3. Matrone A, De Napoli L, Torregrossa L, et al. Core needle biopsy can early and precisely Identify large thyroid masses. Front Oncol 2022;12:854755. doi: 10.3389/fonc.2022.854755.
4. Ahmed S, Ghazarian MP, Cabanillas ME, et al. Imaging of anaplastic thyroid carcinoma. AJNR Am J Neuroradiol 2018;39:547–51. doi: 10.3174/ajnr.A5487.
5. Bible KC, Kebebew E, Brierley J, et al. 2021 American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid 2021;31:337–86. doi: 10.1089/thy.2020.0944.
6. Xiang N, Dong F, Zhan X, et al. Incidence and prognostic factors of primary thyroid lymphoma and construction of prognostic models for post-chemotherapy and postoperative patients: a population-based study. BMC Endocr Disord 2021;21:68. doi: 10.1186/s12902-021-00732-7.
7. Stein SA, Wartofsky L. Primary thyroid lymphoma: a clinical review. J Clin Endocrinol Metab 2013;98:3131–8. doi: 10.1210/jc.2013-1428.
8. Bayrak BY, Paksoy N. Diagnostic accuracy of fine-needle aspiration cytology for extrathyroidal head-and-neck lesions performed by a cytopathologist with the assistance of radiologist: a single-center study. Cytojournal 2025;22:57. doi: 10.25259/Cytojournal_247_2024.
9. Hrizat AS, Doxzon KA, Post RP, et al. Diagnostic accuracy and clinical utility of fine-needle aspiration in breast lesions: a correlation with surgical pathology. Acta Cytol 2025;69:114–21. doi: 10.1159/000542811.
10. Facciorusso A, Crinò SF, Muscatiello N, et al. Endoscopic ultrasound fine-needle biopsy versus fine-needle aspiration for tissue sampling of abdominal lymph nodes: a propensity score matched multicenter comparative study. Cancers (Basel) 2021;13:4298. doi: 10.3390/cancers13174298.
11. Zhang L, Castellana M, Virili C, et al. Fine-needle aspiration to diagnose primary thyroid lymphomas: a systematic review and meta-analysis. Eur J Endocrinol 2019;180:177–87. doi: 10.1530/EJE-18-0672.
12. Vander Poorten V, Goedseels N, Triantafyllou A, et al. Effectiveness of core needle biopsy in the diagnosis of thyroid lymphoma and anaplastic thyroid carcinoma: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022;13: 971249. doi: 10.3389/fendo.2022.971249.
13. Kakkar A, Purkait S, Agarwal S, et al. Primary thyroid lymphoma: a series from a tertiary care center in Northern India. J Cancer Res Ther 2019;15:669–75. doi: 10.4103/jcrt.JCRT_135_17.
14. Xu L, Li S, Zhu J, et al. [High frequency ultrasound combined with ultrasound-guided core needle biopsy for the diagnosis of primary thyroid lymphoma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021;56:858–62. doi: 10.3760/cma.j.cn115330-20201201-00901. Chinese.
15. Cunha C, Mousinho F, Saraiva C, Duarte JS. Follicular lymphoma of the thyroid and the role of core needle biopsy. Endocrinol Diabetes Metab Case Rep 2023:2023: 21-019. doi: 10.1530/EDM-21-0196.
16. Na DG, Baek JH, Jung SL, et al. Core needle biopsy of the thyroid: 2016 consensus statement and recommendations from Korean Society of Thyroid Radiology. Korean J Radiol 2017;18:217. doi: 10.3348/kjr.2017.18.1.217.
17. Jung CK, Baek JH. Recent advances in core needle biopsy for thyroid nodules. Endocrinol Metab 2017;32:407–12. doi: 10.3803/EnM.2017.32.4.407.
18. Pantanowitz L, Thompson LDR, Jing X, Rossi ED. Is thyroid core needle biopsy a valid compliment to fine-needle aspiration? J Am Soc Cytopathol 2020;9:383–8. doi: 10.1016/j.jasc.2020.06.003.
19. Hasannia MA, Pourghorban R, Asefi H, et al. Diagnostic yield of fine needle aspiration with simultaneous core needle biopsy for thyroid nodules. J Pathol Transl Med 2025;59:180. doi: 10.4132/jptm.2025.03.04.
20. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.
21. Schiavo JH. PROSPERO: an international register of systematic review protocols. Med Ref Serv Q 2019;38:171–80. doi: 10.1080/02763869.2019.1588072.
22. Booth A, Mitchell AS, Mott A, et al. An assessment of the extent to which the contents of PROSPERO records meet the systematic review protocol reporting items in PRISMA-P. F1000Res 2020;9:773. doi: 10.12688/f1000research.25181.2.
23. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366: 366:l4898. doi: 10.1136/bmj.l4898.
24. Gualdi-Russo E, Zaccagni L. The Newcastle–Ottawa scale for assessing the quality of studies in systematic reviews. Publications 2026;14:4. doi: 10.3390/publications14010004.
25. Guolo A, Varin C. Random-effects meta-analysis: the number of studies matters. Stat Methods Med Res 2017;26:1500–18. doi: 10.1177/0962280215583568.
26. McKenzie JE, Veroniki AA. A brief note on the random-effects meta-analysis model and its relationship to other models. J Clin Epidemiol 2024;174:111492. doi: 10.1016/j.jclinepi.2024.111492.
27. Migliavaca CB, Stein C, Colpani V, et al. Meta-analysis of prevalence: I2 statistic and how to deal with heterogeneity. Res Synth Methods 2022;13:363–7. doi: 10.1002/jrsm.1547.
28. Shim SR, Kim SJ, Lee J. Diagnostic test accuracy: application and practice using R software. Epidemiol Health 2019;41:e2019007. doi: 10.4178/EPIH.E2019007.
29. Giorgi FM, Ceraolo C, Mercatelli D. The R language: an engine for bioinformatics and data science. 2022;12:648. doi: 10.3390/life12050648.
30. Hilton M. JBI Critical appraisal checklist for systematic reviews and research syntheses. J Can Health Libr Assoc 2024;45:180. doi: 10.29173/jchla29801.
31. Moskalewicz A, Oremus M. No clear choice between Newcastle–Ottawa Scale and Appraisal Tool for Cross-Sectional Studies to assess methodological quality in cross-sectional studies of health-related quality of life and breast cancer. J Clin Epidemiol 2020;120:94–103. doi: 10.1016/j.jclinepi.2019.12.013.
32. Kwak JK, Kim EK, Ko KH, et al. Primary thyroid lymphoma: role of ultrasound-guided needle biopsy. J Ultrasound Med 2007;26:1761–5. doi: 10.7863/jum.2007.26.12.1761.
33. Khoo TK, Baker CH, Hallanger-Johnson J, et al. Comparison of ultrasound-guided fine-needle aspiration biopsy with core-needle biopsy in the evaluation of thyroid nodules. Endocrine Practice 2008;14:426–31. doi: 10.4158/EP.14.4.426.
34. Sarinah B, Hisham AN. Primary lymphoma of the thyroid: diagnostic and therapeutic considerations. Asian J Surg 2010;33:20–4. doi: 10.1016/S1015-9584(10)60004-8.
35. Nam M, Shin JH, Han BK, et al. Thyroid lymphoma: correlation of radiologic and pathologic features. J Ultrasound Med 2012;31:589–94. doi: 10.7863/jum.2012.31.4.589.
36. Hahn SY, Shin JH, Han BK, et al. Ultrasonography-guided core needle biopsy for the thyroid nodule: does the procedure hold any benefit for the diagnosis when fine-needle aspiration cytology analysis shows inconclusive results? Br J Radiol 2013;86. doi: 10.1259/bjr.20130007.
37. Ha EJ, Baek JH, Lee JH, et al. Core needle biopsy could reduce diagnostic surgery in patients with anaplastic thyroid cancer or thyroid lymphoma. Eur Radiol 2016;26:1031–6. doi: 10.1007/s00330-015-3921-y.
38. Wu SY, Chu CH, Duh QY, Hsieh CB, Yu JC, Shih ML. Management for primary thyroid lymphoma: Experience from a single tertiary care centre in Taiwan. Formos J Surg 2016;49:201–7. doi: 10.1016/j.fjs.2016.07.001.
39. Stacchini A, Pacchioni D, Demurtas A, et al. Utilility of flow cytometry as ancillary study to improve the cytologic diagnosis of thyroid lymphomas. Cytometry B Clin Cytom 2015;88:320–9. doi: 10.1002/cyto.b.21204.
40. Lee JS, Shin SJ, Yun HJ, et al. Primary thyroid lymphoma: A single-center experience. Front Endocrinol (Lausanne) 2023;14:1064050. doi: 10.3389/fendo.2023.1064050.
41. Karki SS, Pandey S, Karki S, et al. Diffuse large B‐cell lymphoma of the thyroid in a patient with Hashimoto thyroiditis: a diagnostic dilemma. Clin Case Rep 2025;13:e71346. doi: 10.1002/ccr3.71346.
42. Kim SY, Lee HS, Moon J, et al. Fine-needle aspiration versus core needle biopsy for diagnosis of thyroid malignancy and neoplasm: a matched cohort study. Eur Radiol 2017;27:801-11. doi: 10.1007/s00330-016-4424-1.
43. Jung CK, Baek JH, Na DG, et al. 2019 Practice guidelines for thyroid core needle biopsy: a report of the Clinical Practice Guidelines Development Committee of the Korean Thyroid Association. J Pathol Transl Med 2020;54:64. doi: 10.4132/jptm.2019.12.04.
44. Kim SY, Chung HW, Oh TS, et al. Practical guidelines for ultrasound-guided core needle biopsy of soft-tissue lesions: transformation from beginner to specialist. Korean J Radiol 2017;18:361. doi: 10.3348/kjr.2017.18.2.361.
45. Misiakos EP, Margari N, Meristoudis C, et al. Cytopathologic diagnosis of fine needle aspiration biopsies of thyroid nodules. World J Clin Cases 2016;4:38. doi: 10.12998/wjcc.v4.i2.38.
46. Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association. J Hypertens 2023;41:1874–2071. doi: 10.1097/HJH.0000000000003480.
47. Yim Y, Baek JH. Core needle biopsy in the management of thyroid nodules with an indeterminate fine-needle aspiration report. Gland Surg 2019;8:S77–85. doi: 10.21037/gs.2018.09.07.
48. Bakuła-Zalewska EB, Kwapisz MI, Góralski P, et al. Core needle biopsy: an efficacious adjunct to cytological diagnosis in thyroid tumours suspected of anaplastic carcinoma - single-centre experience. Contemp Oncol (Pozn) 2024;28:167–71. doi: 10.5114/wo.2024.142468.
49. Marcy PY, Bauduer F, Thariat J, et al. Fast track management of primary thyroid lymphoma in the very elderly patient. Curr Oncol 2023;30:5816–27. doi: 10.3390/curroncol30060435.
50. Iskra I, Tomaš MI, Crnčić TB, et al. Two lymphoma histotypes and papillary thyroid carcinoma coexisting on Hashimoto ground: a case report and review of the literature. Diagn Pathol 2024;19:15. doi: 10.1186/s13000-024-01472-7.