Accuracy of core needle biopsy compared to fine needle biopsy for the diagnosis of malignancy in patients with suspected head and neck cancers: A systematic review and meta-analysis of diagnostic test accuracy and comparison of adverse effects

Abstract

Objective: The objective of this review was to compare the diagnostic accuracy of core needle biopsy and fine needle aspiration cytology for patients with a head and neck mass for a diagnosis of malignancy using surgical histopathology as a reference test and to compare the risks and adverse events associated with each technique. Introduction: A proportion of head and neck neoplasms are malignant which can only be determined by a tissue diagnosis. Options for tissue biopsy include - surgical biopsy, fine needle aspiration (FNA), and core needle biopsy (CNB). Insufficient tissue for a diagnosis results in additional delays in patient management. The diagnostic sensitivity and specificity of each option for tissue biopsy in diagnosing a head and neck malignancy has not been evaluated in a meta-analysis. Our review aimed to compare and review the diagnostic accuracy of FNA and CNB for head and neck lesions and assess the risk and adverse events associated with each technique. Inclusion criteria: Studies that compared ultrasound guided CNB and/or FNAC to investigate lumps suspicious for head and neck malignancy in thyroid, cervical lymph nodes, or salivary gland in adult patients were included. The comparator test was definitive histology in the form of surgical biopsy/excision. Methods MEDLINE, EMCARE, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews were searched. Studies were critically appraised by two independent reviewers for methodological quality using the modified critical appraisal instrument QUADAS2 using JBI – SUMARI software. Data was extracted from papers included in the review using a modified data extraction tool available in the JBI Reviewer’s Manual. Meta-analysis was performed using a random-effects model. Comparison of accuracy of the two techniques was achieved by comparing pooled sensitivity and specificity using a bivariable model. The inadequacy rate and inconclusive rate were also pooled for comparison. Summary receiver operating characteristic (ROC) graphs were created to confirm diagnostic accuracy. Narrative review of adverse effects was conducted. Results: Majority of the patients in the included studies compared FNA and CNB for thyroid masses. Data on a total of 1229 patients for FNA and 1135 patients for CNB from six studies met the inclusion criteria and were included in the final meta-analysis. The studies were of moderate-low or unknown quality. While CNB and FNA had similar sensitivity and specificity in diagnosing thyroid malignancy, the non-diagnostic and inadequacy rate for CNB was significantly lower: sensitivity 0.91 (95% CI: 0.79 to 0.96) vs 0.75 (95% CI: 0.66 to 0.83) respectively, specificity 1.00 (95% CI: 0.98 to 1.00) vs 1.00 (95% CI: 0.60 to 1.00) respectively, non-diagnostic rate 0.043 (95% CI: 0.016 to 0.07) vs 0.164 (95% CI: 0.083 to 0.245) respectively, inadequacy rate 0.112 (95% CI: 0.087 to 0.137) vs 0.17 (95% CI: 0.106 to 0.233) respectively (p<0.001). There were no substantial differences in complication rates noted. Conclusion: Sensitivity and specificity of FNA and CNB for diagnosis of thyroid malignancy for FNA and CNB are high. The inadequacy rate and inconclusive rate for CNB is lower than FNA for thyroid malignancy. CNB could be used instead of FNA for diagnosis of thyroid nodules if found to be cost effective. These results need to be treated with caution as the methodological quality of included studies was generally poor, introducing a high risk of bias; while substantial differences in study characteristics resulted in significant between study heterogeneity. Further verification of these results with high quality studies is required.