(A528) Core Needle Biopsy versus Fine Needle Aspiration for Cervical Lymphadenopathy: A Meta-Analysis and Systematic Review

Introduction: Cervical lymphadenopathy is a common presentation in Otolaryngology-Head and Neck Surgery (OHNS), often requiring a biopsy to exclude malignancy. While fine-needle aspiration (FNA) is the conventional first-line approach, recent data on other anatomic sites suggest core needle biopsy (CNB) may offer more accurate detection of malignancy. This study aims to synthesize evidence comparing the diagnostic accuracy and safety of FNA and CNB for cervical lymphadenopathy.

Methods: PubMed, Embase, and Cochrane were searched for studies from 1995-2024 assessing the sensitivity, specificity, and safety of FNA versus CNB for adult cervical lymphadenopathy. Studies on thyroid, parotid, or other neck masses were excluded. Two investigators independently reviewed all identified manuscripts and performed quality assessment and quantitative meta-analysis on included studies using validated tools.

Results: Of 2523 abstracts identified, 6 studies fulfilled eligibility, including 4 retrospective case series, 1 randomized controlled trial (RCT), and 1 retrospective cohort study. Meta-analysis was performed on five studies with extractable data, resulting in a total of 646 patients, of whom 329 received FNA and 317 received CNB. Using a random effects model, pooled sensitivity and specificity, respectively, for FNA (0.75 (p < 0.001) and 0.92 (p < 0.001)) versus CNB (0.95 (p < 0.001) and 0.97 (p < 0.001)) strongly favored CNB, with CNB being 1.27 times more sensitive than FNA in detecting malignancy (p < 0.001). Adverse events were minimal across both groups: there were no cases of nerve injury reported, and no significant difference between FNA and CNB in incidence of minor bleeding (0.6% vs. 1.6%, X^2=2.7, p=0.10) or pain (0% versus 0.3%, X^2=1.0, p=0.32). Study heterogeneity (I^2) and risk of bias was low overall.

Conclusions: CNB provides higher diagnostic accuracy, with limited adverse events, compared to FNA for detecting malignant cervical lymphadenopathy. Increased utilization of CNB should be considered to minimize inconclusive needle biopsy and delayed diagnosis.