Usefulness of Fine Needle Aspiration Biopsy in the Early Diagnosis of Neoplasms
Keywords:
biopsy; fine needle aspiration biopsy; early diagnosis; neoplasms; sensitivity and specificityAbstract
Introduction: Fine needle aspiration biopsy is a minimally invasive technique used for the early diagnosis of tumor lesions.
Objective: To evaluate the usefulness of fine needle aspiration biopsy in the early diagnosis of highly prevalent neoplasms such as thyroid, breast, lymph nodes, and salivary glands.
Methods: A meta-analysis was performed, in which 18 articles (n = 9,752 patients) were considered. Statistical analysis was performed using the random effects model (heterogeneity: I²), Rev Man 5.4 software. A 95% confidence level was used.
Results: The overall diagnostic performance was 88% (sensitivity) and 92% (specificity). The thyroid showed the best performance, except in sensitivity, which was surpassed by the breast, 90% versus 85%. When comparing fine-needle aspiration biopsy with core needle biopsy, the specificity was the same in both (92%), with higher sensitivity in core needle biopsy (92% vs. 85%); in addition, it showed better performance in fibrosis and less need for repetition. However, complications, costs, sample size, and reporting time were better indicators in fine needle aspiration biopsy.
Conclusions: The limitations of this type of biopsy focused on its operator-diagnostic dependence, limited sampling, and difficulty in classifying tumor subtypes; however, it is an irreplaceable technique in the initial diagnosis, provided that it is integrated into a multimodal approach (imaging, histology, and genetics), as its role is the rapid screening of accessible lesions.
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References
1. Zulfa PO, Iqhrammullah M, Zufry H. Diagnostic accuracy of preoperative ultrasonography-guided fine-needle aspiration biopsy in distinguishing malignancy in large thyroid nodules: A systematic review, meta-analysis, and meta-regression. Narra J. 2025;5(1):e1120. DOI: https://doi.org/10.52225/narra.v5i1.1120
2. Fischerova D, Planchamp F, Alcázar JL, Dundr P, Epstein E, Félix A, et al. ISUOG/ESGO Consensus Statement on ultrasound-guided biopsy in gynecological oncology. Ultrasound Obstet Gynecol. 2025;65(4):517-35. DOI: https://doi.org/10.1002/uog.29183
3. Suzuki A, Hirokawa M, Kawakami M, Kudo T, Miyauchi A, Akamizu T. Proposal for Clinical Management of Nodules Diagnosed as Atypia of Undetermined Significance via Thyroid Fine-Needle Aspiration Cytology in the Absence of Molecular Testing. Cytopathology. 2025;36(2):115-22. DOI: https://doi.org/10.1111/cyt.13467
4. Köster J, De Mattos CBR, Domanski HA. Reporting Bone Cytopathology-A Proposal Based on a Single Tertiary Centre Experience. Cytopathology. 2025;36(2):123-39. DOI: https://doi.org/10.1111/cyt.13462
5. Franzén B, Auer G, Lewensohn R. Minimally invasive biopsy-based diagnostics in support of precision cancer medicine. Mol Oncol. 2024;18(11):2612-28. DOI: https://doi.org/10.1002/1878-0261.13640
6. Chou R, Dana T, Mayson SE, Cibas ES, Durante C, Solórzano CC, et al. Ultrasound Follow-Up of Benign Thyroid Nodules: A Scoping Review. Thyroid. 2023;33(4):420-7. DOI: https://doi.org/10.1089/thy.2022.0692
7. Paduani GF, Felipe LM, De Paulo GA, Lenz L, Martins BC, Matuguma SE, et al. Prospective randomized study comparing Franseen 22-gauge vs standard 22-gauge needle for endoscopic ultrasound guided sampling of pancreatic solid lesions. World J Gastrointest Endosc. 2025;17(4):101998. DOI: https://doi.org/.4253/wjge.v17.i4.101998
8. Kostek M, Kostek H, Unlu MT, Caliskan O, Cakir Y, Sengul Z, et al. Deciding on Fine Needle Aspiration Biopsy in Thyroid Incidentalomas in FDG-PET/CT: ¿Should Ultrasonographic Evaluation or FDG Uptake Be in the Foreground? Sisli Etfal Hastan Tip Bul. 2025;59(1):20-7. DOI: https://doi.org/10.14744/SEMB.2025.49140
9. Stoia S, Ciurea A, Băciuț M, Bran S, Armencea G, Boțan E, et al. Comparative Diagnostic Accuracy of Ultrasound, MRI, and Fine-Needle Aspiration Biopsy in the Preoperative Evaluation of Parotid Gland Tumors. J Clin Med. 2025;14(4):1342. DOI: https://doi.org/10.3390/jcm14041342
10. Januś D, Kujdowicz M, Kiszka-Wiłkojć A, Kaleta K, Taczanowska-Niemczuk A, Radliński J, et al. Ultrasound and histopathological assessment of benign, borderline, and malignant thyroid tumors in pediatric patients: an illustrative review and literature overview. Front Endocrinol (Lausanne). 2025;15:1481804. DOI: https://doi.org/10.3389/fendo.2024.1481804
11. Arashloo A, Saffar H, Lotfi M, Ameli F. Effectiveness of The Milan System for Reporting Salivary Gland Cytology: A 5-Year Retrospective Review. Iran J Pathol. 2025;20(1):76-83. DOI: https://doi.org/10.30699/ijp.2024.2021304.3249
12. Kwon Y, Lee MK. Diagnostic Performance and Safety of Ultrasound-Guided Core Needle Biopsy for Diagnosing Lymphoma: A Systematic Review and Meta-Analysis. Cancer Med. 2025;14(1):e70414. DOI: https://doi.org/10.1002/cam4.70414
13. Ding C, Yang JF, Wang X, Zhou YF, Gu Y, Liu Q, et al. Diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration-based cytology for distinguishing malignant and benign pancreatic cystic lesions: A systematic review and meta-analysis. PLoS One. 2025;20(2):e0314825. DOI: https://doi.org/10.1371/journal.pone.0314825
14. Bebek J, Novak N, Dasović M, Divjak E, Tomasović-Lončarić Č, Brkljačić B, et al. Histopathological Analysis of Vacuum-Assisted Breast Biopsy in Relation to Microcalcification Findings on Mammography: A Pictorial Review. Biomedicines. 2025;13(3):737. DOI: https://doi.org/10.3390/biomedicines13030737
15. Cibas ES, Ali SZ. The 2023 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2023 [acceso 16/04/2024];33(7):779-90. Disponible en: https://www.liebertpub.com/doi/10.1089/thy.2023.0141
16. Pan Y, Ran T, Zhang X, Qin X, Zhang Y, Zhou C, et al. Adequacy of EUS-guided fine-needle aspiration and fine-needle biopsy for next-generation sequencing in pancreatic malignancies: A systematic review and meta-analysis. Endosc Ultrasound. 2024;13(6):366-75. DOI: https://doi.org/10.1097/eus.0000000000000097
17. Liu J, Yang C, Wu X, Yang L, Xu H. Cytological Diagnosis by Fine-Needle Aspiration or Core Biopsy with Touch Preparation for Renal Cystic or Solid Lesions: A Single-Center Clinicopathological Analysis. Acta Cytol. 2025;69(2):210-20. DOI: https://doi.org/10.1159/000543822
18. Meng X, Hou R, Zhang M, Chen J, Zhang K, Li J. Histopathological findings of 687 thyroid nodules, suspicious for malignancy on ultrasound, with an indeterminate cytopathological diagnosis after the combination of the Bethesda System and BRAF mutation status. Cytojournal. 2025;22:1. DOI: https://doi.org/10.25259/Cytojournal_97_2024
19. Mukawa S, Koya Y, Murakami T, Miyagawa K, Maruno Y, Yamaguchi K, et al. Rectal metastasis from lung cancer diagnosed by endoscopic ultrasound-guided fine needle biopsy: A case report. DEN Open. 2025;6(1):e70127. DOI: https://doi.org/10.1002/deo2.70127
20. Syed ZA, Vander PA. The Bethesda System for Reporting Thyroid Cytopathology: Definitions, Criteria, and Explanatory Notes. 3 ed. New York City: Springer International Publishing; 2023. DOI: https://doi.org/10.1007/978-3-031-28046-7
21. Pusztaszeri M, Rossi ED, Auger M. Update on the Cytologic Features of Papillary Thyroid Carcinoma: A Systematic Review. Acta Cytol. 2021;65(3):171-84. DOI: https://doi.org/10.1159/000512733
22. Field AS, Raymond WA, Schmitt F. The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology. Acta Cytol. 2019;(4):257-73. DOI: https://doi.org/10.1159/000500704
23. World Health Organization (WHO), International Agency for Research on Cancer. Breast Tumours. WHO Classification of Tumours. 5th ed. Lyon: IARC Press; 2019. [acceso 05/02/2026]. Disponible en: https://publications.iarc.fr/Book-And-Report-Series/Who-Classification-Of-Tumours/Breast-Tumours-2019
24. García L, López G, Boldo E. Trends in Cancer Mortality in Cuba (1990_2020): Challenges for a Middle-Income Country. JCO Glob Oncol. 2022;8:e2100423. DOI: https://doi.org/10.1200/GO.21.00423
25. Rossi ED, Fadda G. Liquid-Based Cytology for Fine-Needle Aspiration Biopsy: A Review of Diagnostic Accuracy for Head and Neck, Pancreas, and Liver. Cancer Cytopathol. 2021;129(12):915-27. DOI: https://doi.org/10.1002/cncy.22489
26. Pantanowitz L, Sharma A, Carter AB. Artificial Intelligence in Cytopathology: A Review of the Literature and Overview of Commercial Landscape. J Am Soc Cytopathol. 2022;11(1):12-20. DOI: https://doi.org/10.1016/j.jasc.2021.09.001
27. Pérez L, Martínez F. Fine-Needle Aspiration Biopsy in Cuba: A Decade of Experience in Resource-Limited Settings. Diagn Cytopathol. 2020;48(10):890-7. DOI: https://doi.org/10.1002/dc.24421
28. International Atomic Energy Agency (IAEA). Strengthening Diagnostic Capacity for Cancer Management in Low-Income Countries: A Global Perspective. Vienna: IAEA; 2021 [acceso 05/02/2026]. Disponible en: https://www.iaea.org/projects/tc/mex6011
29. Faquin W, Rossi ED, Baloch Z, Barkan GA, Pia Foschini M, Kurtycz D, et al. The Milan System for Reporting Salivary Gland Cytopathology. 2nd ed. New York City: Springer International Publishing; 2023 [acceso 05/02/2026]. Disponible en: https://link.springer.com/book/10.1007/978-3-031-26662-1
30. Mayer M, Alfarra MM, Möllenhoff K, Engels M, Arolt C, Quaas A, et al. The Impact of Lesion-Specific and Sampling-Related Factors on Success of Salivary Gland Fine-Needle Aspiration Cytology. Head Neck Pathol. 2025;19(1):1. DOI: https://doi.org/10.1007/s12105-024-01741-3
31. Lin H, Zhang X, Yan N, Guo T, Chen Q, Huang X, et al. Diagnosis and treatment of a rare bilateral primary thyroid cancer: a case report. Front Oncol. 2025;14:1468550. DOI: https://doi.org/10.3389/fonc.2024.1468550
32. Tobcu E, Karavaş E, Yılmaz GT, Topçu B. Comparison of K-TIRADS, EU-TIRADS and ACR-TIRADS Guidelines for Malignancy Risk Determination of Thyroid Nodules. Diagnostics. 2025];15(8):1015. DOI: https://doi.org/10.3390/diagnostics15081015
33. Koc AM, Adıbelli ZH, Erkul Z, Sahin Y, Dilek I. Comparison of diagnostic accuracy of ACR-TIRADS, American Thyroid Association (ATA), and EU-TIRADS guidelines in detecting thyroid malignancy. Eur J Radiol. 2020;133:109390. DOI: https://doi.org/10.1016/j.ejrad.2020.109390
34. Yarman Y, Post R, Breslin Z, Solomides CC, Gargano SM. Utility of Proliferation Markers Ki-67 and PHH3 in Predicting Malignancy in Basaloid Salivary Gland Neoplasms: A Study Using Digital Image Analysis of Cytology Cell Blocks. Diagn Cytopathol. 2025;53(5):238-45. DOI: https://doi.org/10.1002/dc.25453
35. McConnell RJ, Kamysh O, O'Kane PL, Greenebaum E, Rozhko AV, Yauseyenka VV, et al. Radiation Dose Does Not Affect the Predictive Value of Thyroid Biopsy for Diagnosing Papillary Thyroid Cancer in a Belarusian Cohort Exposed to Chernobyl Fallout. Acta Cytol. 2024;68(1):34-44. DOI: https://doi.org/10.1159/000536387
36. Béchade D. Clinical Utility of Endoscopic Ultrasound (EUS) and Endobronchial Ultrasound (EBUS) in the Evaluation of Mediastinal Lymphadenopathy. Diagnostics (Basel). 2025;15(3):349. DOI: https://doi.org/10.3390/diagnostics15030349
37. Song YJ, Lim JK, Choi JH. Role of endoscopic ultrasound in the diagnosis and local ablative therapy of pancreatic neuroendocrine tumors. Korean J Intern Med. 2025;40(2):170-80. DOI: https://doi.org/10.3904/kjim.2024.293
38. Liu TYA, Chen H, Koseoglu ND, Kolchinski A, Unberath M, Correa ZM. Direct Prediction of 48 Month Survival Status in Patients with Uveal Melanoma Using Deep Learning and Digital Cytopathology Images. Cancers (Basel). 2025;17(2):230. DOI: https://doi.org/10.3390/cancers17020230
39. Deniz MS, Ozder N, Narli ZI. The impact of anthropometric parameters and sonographic characteristics on the choice of biopsy method for thyroid nodules: Fine-needle aspiration versus non-aspiration biopsy. Cytojournal. 2024;21:27. DOI: https://doi.org/10.25259/Cytojournal_42_2024
40. Liu T, Yang F, Qiao J, Mao M. Deciphering the progression of fine-needle aspiration: A bibliometric analysis of thyroid nodule research. Medicine (Baltimore). 2024;103(20):e38059. DOI: https://doi.org/10.1097/MD.0000000000038059
41. Verma A, McDowell R, Porreca A. Fine-Needle Aspiration versus the CytoCore® Motorized Rotating Needle Device for Thyroid Nodule Biopsies: A Retrospective Cohort Study. Acta Cytol. 2024;68(5):405-12. DOI: https://doi.org/10.1159/000541374
42. Streinu DR, Neagoe OC, Borlea A, Icma I, Derban M, Stoian D. Enhancing diagnostic precision in thyroid nodule assessment: evaluating the efficacy of a novel cell preservation technique in fine-needle aspiration cytology. Front Endocrinol (Lausanne). 2024;15:1438063. DOI: https://doi.org/10.3389/fendo.2024.1438063
43. Nga ME. Pitfalls in Lymph Node Fine Needle Aspiration Cytology. Acta Cytol 2024;68(3):260-80. DOI: https://doi.org/10.1159/000535906
44. Şenkaya A, Çelik F, Nart D, Oruç N, Ahmet A, Tekin F, et al. Diagnostic Efficacy of Cell Block and Liquid-Based Cytology for Endoscopic Ultrasound-Guided Fine Needle Aspiration in Pancreatic Tumors. Turk J Gastroentero. 2024;35(8):665-74. DOI: https://doi.org/10.5152/tjg.2024.23609
45. Zhao Y, Xiong D, Aruna, Chen Q, Kuang D, Xiong S, et al. Fine needle biopsy versus fine needle aspiration in the diagnosis of immunohistochemistry-required lesions: A multicenter study with prospective evaluation. Endosc Ultrasound. 2023;12(6):456-64. DOI: https://doi.org/10.1097/eus.0000000000000028
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