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%, I2= 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.