, Volume 57, Issue 1, pp 108–114 | Cite as

Ultrasound-guided fine needle aspiration versus core needle biopsy: comparison of post-biopsy hematoma rates and risk factors

  • In Hye Chae
  • Eun-Kyung Kim
  • Hee Jung Moon
  • Jung Hyun Yoon
  • Vivian Y. Park
  • Jin Young KwakEmail author
Original Article



To compare post-biopsy hematoma rates between ultrasound guided-fine needle aspiration and ultrasound guided-core needle biopsy, and to investigate risk factors for post-biopsy hematoma.


A total of 5304 thyroid nodules which underwent ultrasound guided biopsy were included in this retrospective study. We compared clinical and US features between patients with and without post-biopsy hematoma. Associations between these features and post-biopsy hematoma were analyzed.


Post-biopsy hematoma rate was 0.8% (43/5121) for ultrasound guided-fine needle aspiration and 4.9% (9/183) for ultrasound guided-core needle biopsy (P < 0.001). For ultrasound guided-fine needle aspiration, gender, age, size, presence of vascularity, and suspicious US features were not associated with post-biopsy hematoma according to experience level. Post-biopsy hematoma occurred significantly more with ultrasound guided-core needle biopsy (9/179, 5.0%) than with ultrasound guided-fine needle aspiration (9/1138, 0.8%) (P < 0.001) in experienced performers and ultrasound guided-core needle biopsy was the only significant risk factor for post-biopsy hematoma (adjusted Odds Ratio, 6.458, P < 0.001).


Post-biopsy hematoma occurred significantly more in ultrasound guided-core needle biopsy than in ultrasound guided-fine needle aspiration and ultrasound guided-core needle biopsy was the only independent factor of post-biopsy hematoma in thyroid nodules.


Thyroid Ultrasonography Fine needle aspiration biopsy Core needle biopsy Hematoma 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    B.R.M. Haugen, E.K. Alexander, K.C. Bible, G. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G. Randolph, A. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D. Steward, R.M.M. Tuttle, L. Wartofsky, 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 26(1), 1–133 (2015)CrossRefGoogle Scholar
  2. 2.
    J.H. Yoon, H.J. Moon, E.K. Kim, J.Y. Kwak, Inadequate cytology in thyroid nodules: should we repeat aspiration or follow-up? Ann. Surg. Oncol. 18(5), 1282–1289 (2011)CrossRefGoogle Scholar
  3. 3.
    J.H. Yoon, E.K. Kim, J.Y. Kwak, H.J. Moon, Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules: review of current literature. J. Pathol. Transl. Med. 49(3), 230–235 (2015)CrossRefGoogle Scholar
  4. 4.
    A.C. Nachiappan, Z.A. Metwalli, B.S. Hailey, R.A. Patel, M.L. Ostrowski, D.M. Wynne, The thyroid: review of imaging features and biopsy techniques with radiologic-pathologic correlation. Radiographics 34(2), 276–293 (2014)CrossRefGoogle Scholar
  5. 5.
    H. Gharib, E. Papini, R. Paschke, D.S. Duick, R. Valcavi, L. Hegedus, P. Vitti, American association of clinical endocrinologists, associazione medici endocrinologi, and European thyroid association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. J. Endocrinol. Invest. 33(5 Suppl), 51–56 (2010)PubMedGoogle Scholar
  6. 6.
    Y.H. Kim, H.J. Kwon, E.K. Kim, J.Y. Kwak, H.J. Moon, J.H. Yoon, Applying ultrasound-guided core needle biopsy for diagnosis of thyroid masses: preliminary results from a single institution. J. Ultrasound. Med. 34(10), 1801–1808 (2015)CrossRefGoogle Scholar
  7. 7.
    E. Novoa, N. Gurtler, A. Arnoux, M. Kraft, Role of ultrasound-guided core-needle biopsy in the assessment of head and neck lesions: a meta-analysis and systematic review of the literature. Head Neck 34(10), 1497–1503 (2012)CrossRefGoogle Scholar
  8. 8.
    B.T. Chen, A.B. Jain, A. Dagis, P. Chu, L. Vora, E. Maghami, B. Salehian, Comparison of the efficacy and safety of ultrasound-guided core needle biopsy versus fine-needle aspiration for evaluating thyroid nodules. Endocr. Pract. 21(2), 128–135 (2015)CrossRefGoogle Scholar
  9. 9.
    E.J. Ha, J.H. Baek, J.H. Lee, J.K. Kim, Y.J. Choi, T.Y. Sung, T.Y. Kim, Complications following US-guided core-needle biopsy for thyroid lesions: a retrospective study of 6,169 consecutive patients with 6,687 thyroid nodules. Eur. Radiol. 27(3), 1–9 (2016)Google Scholar
  10. 10.
    T.K. Khoo, C.H. Baker, J. Hallanger-Johnson, A.M. Tom, C.S. Grant, C.C. Reading, T.J. Sebo, J.C. Morris, 3rd: comparison of ultrasound-guided fine-needle aspiration biopsy with core-needle biopsy in the evaluation of thyroid nodules. Endocr. Pract. 14(4), 426–431 (2008)CrossRefGoogle Scholar
  11. 11.
    M. Bergeron, D. Beaudoin, Simple core-needle biopsy for thyroid nodule, complicated tinnitus. Eur. Thyroid. J. 3(2), 130–133 (2014)CrossRefGoogle Scholar
  12. 12.
    S.A. Polyzos, A.D. Anastasilakis, Clinical complications following thyroid fine-needle biopsy: a systematic review. Clin. Endocrinol. 71(2), 157–165 (2009)CrossRefGoogle Scholar
  13. 13.
    J.N. Harvey, D. Parker, P. De, R.K. Shrimali, M. Otter, Sonographically guided core biopsy in the assessment of thyroid nodules. J. Clin. Ultrasound. 33(2), 57–62 (2005)CrossRefGoogle Scholar
  14. 14.
    K.A. Newkirk, M.D. Ringel, J. Jelinek, A. Mark, L. Wartofsky, Z.E. Deeb, R.B. Sessions, K.D. Burman, Ultrasound-guided fine-needle aspiration and thyroid disease. Otolaryngol. Head Neck Surg. 123(6), 700–705 (2000)CrossRefGoogle Scholar
  15. 15.
    M. Braga, T.C. Cavalcanti, L.M. Collaco, H. Graf, Efficacy of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of complex thyroid nodules. J. Clin. Endocrinol. Metab. 86(9), 4089–4091 (2001)CrossRefGoogle Scholar
  16. 16.
    J.L. Roh, Intrathyroid hemorrhage and acute upper airway obstruction after fine needle aspiration of the thyroid gland. Laryngoscope 116(1), 154–156 (2006)CrossRefGoogle Scholar
  17. 17.
    T. Hor, S.W. Lahiri, Bilateral thyroid hematomas after fine-needle aspiration causing acute airway obstruction. Thyroid 18(5), 567–569 (2008)CrossRefGoogle Scholar
  18. 18.
    E.K. Kim, C.S. Park, W.Y. Chung, K.K. Oh, D.I. Kim, J.T. Lee, H.S. Yoo, New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. Am. J. Roentgenol. 178(3), 687–691 (2002)CrossRefGoogle Scholar
  19. 19.
    D.G. Na, J.-h Kim, J.Y. Sung, J.H. Baek, K.C. Jung, H. Lee, H. Yoo, Core-needle biopsy is more useful than repeat fine-needle aspiration in thyroid nodules read as nondiagnostic or atypia of undetermined significance by the Bethesda system for reporting thyroid cytopathology. Thyroid 22(5), 468–475 (2012)CrossRefGoogle Scholar
  20. 20.
    J.S. Pyo, J.H. Sohn, G. Kang, Core needle biopsy is a more conclusive follow-up method than repeat fine needle aspiration for thyroid nodules with initially inconclusive results: a systematic review and meta-analysis. J. Pathol. Transl. Med. 50(3), 217–224 (2016)CrossRefGoogle Scholar
  21. 21.
    J.Y. Sung, D.G. Na, K.S. Kim, H. Yoo, H. Lee, J.H. Kim, J.H. Baek, Diagnostic accuracy of fine-needle aspiration versus core-needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort. Eur. Radiol. 22(7), 1564–1572 (2012)CrossRefGoogle Scholar
  22. 22.
    B. Al Knawy, M. Shiffman, Percutaneous liver biopsy in clinical practice. Liver Int. 27(9), 1166–1173 (2007)CrossRefGoogle Scholar
  23. 23.
    G. Mitsuyoshi, N. Naito, A. Kawai, T. Kunisada, A. Yoshida, H. Yanai, S. Dendo, T. Yoshino, S. Kanazawa, T. Ozaki, Accurate diagnosis of musculoskeletal lesions by core needle biopsy. J. Surg. Oncol. 94(1), 21–27 (2006)CrossRefGoogle Scholar
  24. 24.
    W. Bruening, J. Fontanarosa, K. Tipton, J.R. Treadwell, J. Launders, K. Schoelles, Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions. Ann. Intern. Med. 152(4), 238–246 (2010)CrossRefGoogle Scholar
  25. 25.
    S.Y. Kim, H.S. Lee, J. Moon, E.K. Kim, H.J. Moon, J.H. Yoon, J.Y. Kwak, Fine-needle aspiration versus core needle biopsy for diagnosis of thyroid malignancy and neoplasm: a matched cohort study. Eur. Radiol. 27(2), 801–811 (2017)CrossRefGoogle Scholar
  26. 26.
    N. Nasrollah, P. Trimboli, F. Rossi, S. Amendola, L. Guidobaldi, C. Ventura, R. Maglio, G. Nigri, F. Romanelli, S. Valabrega, Patient’s comfort with and tolerability of thyroid core needle biopsy. Endocrine 45(1), 79–83 (2014)CrossRefGoogle Scholar
  27. 27.
    P. Trimboli, A. Crescenzi, Thyroid core needle biopsy: taking stock of the situation. Endocrine 48(3), 779–785 (2015)CrossRefGoogle Scholar
  28. 28.
    A. Carpi, G. Rossi, A. Nicolini, G. Iervasi, M. Russo, J. Mechanick, Does large needle aspiration biopsy add pain to the thyroid nodule evaluation? PLoS One 8(3), e58016 (2013)CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • In Hye Chae
    • 1
    • 2
  • Eun-Kyung Kim
    • 1
  • Hee Jung Moon
    • 1
  • Jung Hyun Yoon
    • 1
  • Vivian Y. Park
    • 1
  • Jin Young Kwak
    • 1
    Email author
  1. 1.Department of Radiology, Research Institute of Radiological Science, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of RadiologyNational Cancer CenterGoyangRepublic of Korea

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