The prevalence of high-resolution imaging has led to thyroid nodules' meteoric rise in the clinical landscape. Even though the majority of thyroid nodules are innocuous, it is critical to make a precise and timely diagnosis in order to begin the appropriate treatment. It is possible that a tiny fraction of nodules are malignant. Correctly differentiating benign nodules from malignant ones is crucial for preventing unnecessary surgical procedures and guaranteeing early treatment of thyroid cancers [1-3].

Thyroid nodule evaluations have traditionally begun with fine-needle aspiration cytology (FNAC). One of the shortcomings of FNAC is that it cannot assess tissue architecture, has inadequate sampling, and produces indeterminate results. One of these non-traditional ways of diagnosis that is gaining popularity is ultrasound-guided core needle biopsy (CNB). If the results of cytology are not apparent, CNB provides larger tissue samples for histological examination, which ultimately leads to more precise diagnosis [4, 5].

The surgical removal of the affected tissue, as in a lobectomy or total thyroidectomy, is still the most reliable method for histological diagnosis. Nevertheless, being an invasive operation, there are dangers such as nerve injury, hypocalcemia, and increased healthcare expenses. Credible, non-invasive diagnostic tools are, hence, of the utmost importance [6, 7].

Improved sampling accuracy, reduced treatment frequency, and real-time imaging guidance are just a few of the many advantages of ultrasound-guided CNB. In addition to identifying benign from malignant thyroid nodules, it may reduce the number of unnecessary procedures. Surgical excision and ultrasound-guided core needle biopsy are two methods for histologically diagnosing thyroid nodules; this study will compare the two to see which is more effective as a less invasive alternative to surgery [8-10].

This prospective comparative study was conducted at the Department of Radiology, Mahavir Institute of Medical Sciences, Shivareddypet, Vikarabad, Ranga Reddy District, Telangana, between September 2024 to August 2025. The study included 30 patients presenting with thyroid nodules, referred for diagnostic evaluation. Informed consent was obtained from all participants, and ethical approval was secured from the Institutional Ethics Committee. Procedure: All patients underwent detailed clinical examination followed by high-resolution ultrasonography of the thyroid gland to assess the size, number, and characteristics of the nodules. Subsequently, ultrasound-guided core needle biopsy (CNB) was performed using a sterile technique and automated biopsy gun to obtain adequate tissue samples. The procedure was carried out under real-time ultrasound guidance to ensure precise needle placement. Following CNB, all patients underwent surgical excision of the thyroid nodule (lobectomy or total thyroidectomy, as clinically indicated). The excised specimens were subjected to histopathological examination, which was considered the gold standard. The histopathological findings of CNB were compared with those obtained from surgical excision to evaluate diagnostic accuracy. Inclusion Criteria: ● Patients aged 18 years and above with clinically or radiologically detected thyroid nodules. ● Patients willing to undergo both core needle biopsy and surgical excision. ● Patients with solid or mixed thyroid nodules suitable for biopsy. Exclusion Criteria: ● Patients with bleeding disorders or contraindications to biopsy. ● Patients with purely cystic thyroid nodules. ● Patients unfit for surgery or unwilling to undergo surgical excision. ● Patients with previously diagnosed thyroid malignancy undergoing follow-up. Statistical Analysis: Data were entered and analyzed using appropriate statistical software. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated for ultrasound-guided core needle biopsy using surgical histopathology as the reference standard. Concordance between CNB and surgical findings was assessed. Chi-square test was used to determine statistical significance, with a p-value <0.05 considered significant.

A total of 30 patients with thyroid nodules were evaluated using ultrasound-guided core needle biopsy (CNB) and compared with surgical histopathological findings.

Table 1: Age Distribution of Patients

The majority of patients were in the 31–40 years age group (30%), followed by 41–50 years (26.67%). This indicates that thyroid nodules were more prevalent in middle-aged individuals.

Table 2: Gender Distribution

A higher proportion of females (73.33%) was observed compared to males (26.67%), reflecting the known higher prevalence of thyroid nodules among women.

Table 3: Histopathological Distribution (Surgical Specimens)

Based on surgical histopathology, 66.67% of nodules were benign and 33.33% were malignant, indicating that benign lesions were more common in the study population.

Table 4: CNB Diagnosis vs Surgical Histopathology

CNB correctly identified 18 benign and 9 malignant cases. There were 2 false-positive and 1 false-negative cases, demonstrating a strong agreement between CNB and surgical histopathology.

Table 5: Diagnostic Performance of CNB

When it came to identifying thyroid cancers, ultrasound-guided CNB demonstrated excellent sensitivity (90%) and specificity (90%). Its high NPV (94.74%) and overall diagnostic accuracy (90%) indicate its utility in ruling out cancer.

Table 6: Concordance between CNB and Surgical Histopathology

The remarkable dependability of CNB as a diagnostic modality was demonstrated by the high concordance rate of 90% between CNB and surgical histological results.

This study compared the histopathological accuracy of surgical excision with that of ultrasound-guided core needle biopsy (CNB) in order to determine which method is more effective for diagnosing thyroid nodules. In order to direct proper treatment and prevent needless surgical procedures, accurate preoperative diagnosis is crucial [11, 12].

Consistent with other research showing a greater prevalence of thyroid nodules in women, the majority of patients in this study were female and fell within the age range of 31–40. Hormonal effects and greater healthcare seeking behavior may explain why women have a higher prevalence [13, 14].

The vast majority of nodules (66.67%), according to histopathological analysis of surgical specimens in this investigation, were benign; just 33.33% were found to be malignant. Consistent with earlier research, this distribution shows that the majority of thyroid nodules are benign and just a small percentage are malignant [15-17].

A total diagnostic accuracy of 90%, together with 90% sensitivity and specificity, were indicative of strong diagnostic performance for ultrasound-guided CNB in this investigation. These results corroborate those of earlier research that found CNB to be highly sensitive and specific in identifying thyroid nodules that were either benign or cancerous. The present study found that CNB had a high negative predictive value of 94.74%, which means it is effective for ruling out cancer and lowering the need for unneeded procedures [18, 19].

In this study, surgical histology and CNB had a 90% concordance rate, suggesting that the two approaches were highly concordant. Earlier investigations have also demonstrated good concordance rates, demonstrating that CNB is a reliable preoperative diagnostic tool [20].

There were certain restrictions in this study, despite its benefits. The histological characteristics of benign and malignant tumors can overlap, leading to false-positive instances; on the other hand, sampling errors or nodule heterogeneity can provide false-negative results. Acquiring sufficient tissue samples also relies heavily on operator skill and technique [21, 22].

Minimally invasive, inexpensive, and linked with less problems are just a few of the benefits that CNB offers over surgical excision. It lessens patient morbidity and can be done as an outpatient procedure. When biopsy results are unclear or cause concern, surgical excision is still the gold standard for diagnosis and treatment [23, 24].

Taken together, the results of this study lend credence to the idea that ultrasound-guided core needle biopsy is a solid method for identifying thyroid nodules. Under the right circumstances, it can greatly cut down on needless surgeries without sacrificing diagnostic precision [25]. Validating these findings and establishing CNB as a routine diagnostic tool in the evaluation of thyroid nodules requires more investigations with bigger sample sizes and consistent methodologies [26].

This study shows that ultrasound-guided core needle biopsy (CNB) is a reliable, minimally invasive, and accurate thyroid nodule diagnosis method. Compared to surgical histology, the gold standard, it has great sensitivity, specificity, and diagnostic accuracy. The remarkable concordance between CNB and surgical excision shows its preoperative diagnostic efficacy. CNB's excellent negative predictive value helps rule out malignancy, preventing unnecessary surgery. CNB is useful in everyday clinical practice due to its reduced invasiveness, cost, and problems, despite sampling mistakes and operator dependency. To diagnose thyroid nodules, ultrasound-guided CNB is indicated first, with surgical removal reserved for selected or inconclusive cases. More large-scale investigations are needed to confirm these findings and standardize its therapeutic use. Funding None Conflict of Interest: None

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