Complications following ultrasound-guided core needle biopsy of thyroid nodules: a systematic review and meta-analysis

Abstract

Objectives: To identify the complication rate associated with US-guided core needle biopsy (CNB) of thyroid lesions using a systematic review and meta-analysis.

Methods: Ovid-MEDLINE and EMBASE databases were searched for studies on US-guided CNB of thyroid lesions from 1 January 1994-13 December 2016. A review of 393 potential papers identified 39 eligible papers including 14,818 patients. The pooled proportions of complications were assessed using random-effects modelling. Subgroup analysis was performed. Among-study heterogeneity was explored using χ² statistic for pooled estimates and inconsistency index I². Quality of the studies was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies.

Results: The pooled proportion of overall complications after CNB of thyroid lesions was 1.11% (95% CI: 0.64-1.51, I²: 87.2%). The pooled proportion of major complications (0.06% [95% CI: 0.02-0.10], I²: 0.0%) was much lower than that of minor complications (1.08%[95% CI: 0.63-1.53], I²: 93.17%). Subgroup analysis revealed no significant differences between studies on Asian versus non-Asian groups (p=0.7769), radiologist versus non-radiologist groups (p=0.8607), nodule size <20 mm versus nodule size ≥20 mm (p=0.1591) groups, CNB versus CNB-plus-FNA groups (p=0.9281) and studies performed before and after 2012 (p=0.6251). The overall quality of the included studies was moderate with all of the studies satisfying five or more of the eight total domains.

Conclusion: Various complications can occur after US-guided CNB of thyroid lesions. However, the procedure is safe, with a low complication rate.

Key points: • Various complications occurred after CNB of thyroid lesions, but the pooled complication rate was low (1.11%, I ² = 87.2%). • The pooled proportion of major complications (0.06%) was much lower than that of minor complications (1.08%). • There was no significant differences between studies on Asian vs. non-Asian groups, radiologist vs. non-radiologist groups, nodule size <20 mm vs. nodule size ≥20 mm groups, CNB vs. CNB-plus-FNA groups, or studies performed before 2012 vs. after 2012.

Keywords: Core needle biopsy; Meta-analysis; Safety; Thyroid nodule; Ultrasonography.