Core needle biopsy in the diagnosis of anaplastic thyroid carcinoma and other aggressive forms of head and neck tumours

BACKGROUND: The most aggressive head and neck malignant tumours are still a great medical and social problem due to the known difficulties both at the diagnostic stage and in the choice of molecular-personalized treatment strategy. The most rapid and accurate morphological (histological, immunohistochemical, molecular genetic) diagnosis is of fundamental importance. Fine-needle aspiration biopsy is often insufficient for these tasks, particularly in large, rapidly growing tumors and after radiotherapy, when pronounced fibrosis reduces the diagnostic yield of cytology. An alternative to incisional biopsy — which carries anesthetic risks in patients with bulky cervical tumor masses — is core needle biopsy, which enables procurement of representative tissue cores for comprehensive histologic, immunohistochemical, and molecular-genetic studies within a short timeframe.

AIM: To evaluate the diagnostic yield, clinical utility, and safety of core needle biopsy in the workup of anaplastic thyroid carcinoma, lymphoproliferative disorders, and other aggressive neck tumors, including the feasibility of performing valid histologic, immunohistochemical, and molecular-genetic assays on the obtained material and the impact of the results on initial therapeutic decision-making.

MATERIALS AND METHODS: In the period 2017–2025, a total of 131 core needle biopsies were performed at Saint-Petersburg State University for patients with anaplastic thyroid carcinoma, lymphoproliferative diseases and other aggressive tumours. The technique of core needle biopsy of neck tumours is described in detail.

RESULTS: Among all patients who underwent core needle biopsy, on the basis of histological and immunohistochemical methods the diagnosis of anaplastic carcinoma was established in 79 patients (60.3%), lymphoma — in 22 patients (16.8%), other tumours and non-tumours — in 30 patients (22.9%). According to the data of genetic studies, BRAFV600E mutation was detected in 27 patients with anaplastic carcinoma, one mutation in NRAS codon 61 of Q61K type (181C>A); one case of mutation in NTRK3 gene (ex15) was detected.

CONCLUSION: Core needle biopsy of thyroid, neck tumours and neck lymph nodes is a simple, minimally invasive and effective intervention with high informative and diagnostic value. The advantage of this method is the possibility of obtaining sufficient material to study the structural and cellular characteristics of the tumour, to perform valid immunohistochemical and molecular genetic studies.

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