Search Results (709)

Background and Clinical Significance: Histiocytic sarcoma is a rare and aggressive hematopoietic malignancy, which is particularly uncommon in the head and neck region and exceedingly rare within lymph nodes associated with salivary glands. The present study aims to describe the clinical, radiologic, histopathologic, and immunophenotypic features of a primary histiocytic sarcoma, arising in a lymph node within the submandibular gland, and to highlight the diagnostic challenges and management considerations through a correlation with the existing literature. Case presentation: This case report was conducted according to the CARE guidelines. A 93-year-old male presented with a progressively enlarging mass at the right submandibular region. Clinical examination, magnetic resonance imaging, and fine-needle aspiration cytology were performed, raising suspicion for a malignancy. The patient underwent surgical excision of the right submandibular gland with limited level I_b lymph node dissection. Histopathological evaluation combined with an extensive immunohistochemical panel established the diagnosis of histiocytic sarcoma. The tumor was composed of pleomorphic epithelioid and spindle-shaped cells with marked cytologic atypia and high mitotic activity. Immunohistochemistry demonstrated strong positivity for histiocytic markers (CD163, CD68, CD14) and negativity for epithelial, lymphoid, and dendritic cell markers, allowing for the exclusion of major differential diagnoses. The proliferative index (Ki-67) was approximately 90%, indicating aggressive biological potential. FDG PET-CT performed two months after surgery showed no evidence of residual, regional, or distant disease. Considering the localized presentation and the patient’s advanced age, no adjuvant therapy was administered. During follow-up, no evidence of recurrence or disease progression was observed. Conclusions: Primary histiocytic sarcoma involving a lymph node within the submandibular gland is extremely rare and may clinically and cytologically mimic other malignancies. Accurate diagnosis relies on comprehensive immunohistochemical evaluation and exclusion of phenotypic mimickers. A review of previously reported cases of cervical lymph node histiocytic sarcoma demonstrated an age range from 35 to 80 years, with a male predominance and a higher incidence in Asian countries. Most cases presented with localized cervical lymph node disease. Surgical excision was the most commonly applied treatment, and was frequently associated with favorable outcomes, with several patients remaining disease-free during follow-up periods ranging from 24 to 48 months. The accumulation of additional well-documented cases is essential to improve diagnostic accuracy and guide evidence-based treatment strategies for this uncommon entity. Full article

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used for diagnosing pulmonary diseases causing mediastinal lymphadenopathy. However, non-diagnostic results may occur. This study investigated factors associated with non-diagnostic cytological results in EBUS-TBNA. Methods: This retrospective study included patients who underwent EBUS-TBNA at a tertiary hospital between March 2019 and December 2023. Data on demographics, biopsy techniques, cyto-/histopathological results, sonographic lymph node measurements, and pre-procedural PET-CT SUVmax values were recorded. Cytological results were classified as diagnostic or non-diagnostic. We analyzed the characteristics and associated factors of patients who were non-diagnostically identified. Results: Among 776 patients undergoing EBUS-TBNA, 502 (64.7%) were male, with a mean age of 61.5 ± 12.6 years. A total of 1110 lymph nodes were sampled. Of the patients, 14.1% had a non-diagnostic cytology. Among the diagnosed patients, cytological findings showed 58.9% non-malignant, 41.1% malignant. The most sampled station was station 7 (72.9%), with an average of 5.9 ± 1.4 aspirations. Diagnostic cases had significantly more aspirations (p = 0.022) and sampled larger lymph node sizes (p < 0.001). Each 1 mm increase in lymph node size raised the likelihood of diagnostic results by 1.04 times (adjOR = 1.04, 95% CI = 1.02–1.08, p = 0.002). The largest lymph node size significantly predicted diagnostic results (AUROC = 0.611, p < 0.001). A cut-off of 19.55 mm had 67.0% sensitivity and 52.2% specificity. Conclusions: Sampled larger lymph nodes increase diagnostic yield in EBUS-TBNA, reducing the need for repeat procedures and enabling earlier treatment, thereby decreasing morbidity and mortality. Full article

Background/Objectives: Trichoblastoma is a benign follicular adnexal tumor that typically arises on the head and neck. Large variants at atypical locations pose considerable diagnostic challenges because their clinical presentation can be indistinguishable from malignant soft tissue neoplasms. Herein, we describe a case of trichoblastoma presenting as a large subcutaneous thigh mass that was correctly diagnosed by fine-needle aspiration cytology. Case Presentation: A 49-year-old male presented with a 7 cm, slowly enlarging, subcutaneous mass in the left thigh of 20 years’ duration. Magnetic resonance imaging raised the possibility of a low-grade sarcoma. Fine-needle aspiration cytology yielded cohesive clusters of basaloid cells with peripheral palisading, delicate spindle-shaped follicular stromal cells intimately admixed with the epithelial component, and orangeophilic keratinous material in the background. The absence of nuclear atypia, mitotic figures, and mucinous stroma supported a preoperative cytological diagnosis of a benign follicular germinative tumor consistent with trichoblastoma, thereby guiding conservative surgical excision. Histopathological examination confirmed the diagnosis. Immunohistochemistry revealed focally positive BerEP4, CD34-positive stroma, negative androgen receptor, and positive bcl-2, consistent with trichoblastoma and distinguishing the tumor from basal cell carcinoma. The patient remained recurrence-free 12 months after surgery. Conclusions: Careful assessment of characteristic cytomorphological features, particularly a dual population of basaloid epithelial cells with peripheral palisading and specialized follicular stromal cells, is vital for the accurate preoperative cytological characterization of trichoblastoma, even at atypical anatomical sites. Full article

Background: Primary thyroid lymphoma (PTL) is a rare malignancy, accounting for less than 5% of thyroid cancers and less than 2% of extranodal lymphomas. It predominantly affects older women and is strongly associated with autoimmune thyroiditis, particularly Hashimoto’s thyroiditis. Diagnosis is often challenging due to non-specific clinical, imaging, and cytological findings, and the role of surgery has progressively shifted from therapeutic to primarily diagnostic. Methods: We conducted a retrospective single-center case series including nine patients treated for PTL between 2015 and 2025 at a tertiary referral endocrine surgery center. An analysis was conducted on clinical presentation, pre-existing thyroid disease, diagnostic work-up, histopathological subtypes, treatment strategies and outcomes. All patients underwent preoperative ultrasound and fine-needle aspiration cytology (FNAC); surgical intervention was performed to confirm cytology results, when cytology was inconclusive or when compressive symptoms were present. Results: The cohort included six females and three males, with a median age of 65.2 years. Four patients had Hashimoto’s thyroiditis and three had multinodular goiter. FNAC was diagnostic or suggestive of lymphoma in three cases only, and surgical biopsy or thyroidectomy for a definitive diagnosis was performed in eight cases. One case started follow-up after cytology and flow cytometry. Histological subtypes were heterogeneous, including diffuse large B-cell lymphoma, Burkitt’s lymphoma, Hodgkin lymphoma, follicular lymphoma, high-grade B-cell lymphoma, and MALT lymphoma. Seven patients received combined chemoimmunotherapy. A complete response was obtained in eight patients, with a minimum follow-up of three years; one patient died of unrelated causes. Conclusions: PTL remains a rare and diagnostically challenging thyroid malignancy. FNAC alone is frequently insufficient, and surgical biopsy retains an important role in cases with high clinical suspicion or compressive symptoms. While surgery has limited therapeutic value, a multidisciplinary approach and timely, tailored treatment are crucial to achieving favorable outcomes. Full article

Background: The parathyroid hormone (PTH) measurements in washouts from the fine-needle aspiration biopsy (FNAB) of parathyroid adenoma could be considered in preoperative diagnostics of primary hyperparathyroidism (PHPT). Aims: Preoperative remission of PHPT following FNAB is presented, with discussion of the possible pathophysiological mechanisms and clinical implications. Case presentation: We describe a case of a female patient with confirmed PHPT and a suspected parathyroid adenoma who underwent FNAB with PTH washout measurement as part of the diagnostics. Following FNAB, the patient experienced normalization of biochemical parameters, accompanied by a reduction in tumor size. This outcome is presumed to be associated with autoinfarction or hemorrhage within the adenoma triggered by the biopsy procedure. Conclusions: This case highlights a rare but clinically significant phenomenon of FNAB-induced remission of PHPT and explains why alternative treatments such as thermal ablation may be considered to avoid surgery. Full article

Background: Indeterminate thyroid nodules classified as TIR3 according to the SIAPEC-IAP classification represent a heterogeneous group with variable malignancy risk, complicating clinical management. The reclassification of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has further influenced risk estimates. Methods: We conducted a retrospective single-center study including adult patients who underwent ultrasound-guided fine-needle aspiration cytology followed by thyroid surgery between January 2016 and September 2025. Cytological diagnoses were classified according to the SIAPEC-IAP system and correlated with final histology. Ultrasound risk stratification was performed according to EU-TIRADS criteria. Risk of malignancy (ROM) and cytology–histology concordance were assessed, including the impact of NIFTP reclassification. Results: A total of 228 patients were included, with an overall malignancy rate of 27.6%. TIR3A nodules showed a significantly lower ROM than TIR3B (15.6% vs. 48.7%), decreasing to 12.5% and 41.4%, respectively, after exclusion of NIFTP. Cytology–histology agreement was substantial (κ = 0.72). Ultrasound features associated with malignancy included microcalcifications, irregular margins, taller-than-wide shape, and EU-TIRADS ≥4. The BRAF V600E mutation was significantly associated with malignant histology. Conclusions: TIR3A and TIR3B nodules exhibit markedly different malignant potential and should not be managed as a homogeneous group. NIFTP significantly modifies malignancy risk estimates and represents an important source of potential overtreatment. Integration of cytological subclassification with ultrasound and molecular findings improves preoperative risk stratification and supports personalized management of indeterminate thyroid nodules. Full article

This systematic review and meta-analysis evaluate the comparative diagnostic efficacy and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and transbronchial mediastinal cryobiopsy (EBUS-TBMC) for sampling mediastinal and hilar lymph nodes. Following the PRISMA 2020 guidelines, 20 studies published between January 2020 and July 2025 were analysed to provide a comprehensive performance overview. The results demonstrate that EBUS-TBMC offers a significantly higher overall diagnostic efficacy compared to EBUS-TBNA, with a pooled risk difference (RD) of 0.30 (95% CI: 0.17–0.44, p < 0.001). The subgroup analyses revealed a trend toward a superior yield for EBUS-TBMC in lymphoma (RD 0.11, p = 0.05) and sarcoidosis (RD 0.03, p = 0.077), while no significant differences were found for lung cancer subtypes. Safety profiles remained comparable, with no significant differences in the risk of pneumothorax (RD 0.00, p = 1.00) or bleeding (RD 0.00, p = 0.965). In conclusion, these findings support integrating EBUS-TBMC into diagnostic algorithms when preserved tissue architecture is critical, such as for lymphoproliferative disorders, granulomatous diseases, and advanced molecular profiling, providing a safe and more effective alternative to conventional needle aspiration. Full article

Background: Fine-needle aspiration thyroglobulin (FNA-Tg) is widely used to detect lymph node metastases in differentiated thyroid cancer (DTC), but optimal cut-off values remain controversial. Anti-thyroglobulin antibodies (anti-Tg), present in 25–40% of DTC patients, may interfere with FNA-Tg measurements. This study aimed to evaluate whether anti-Tg status necessitates different FNA-Tg diagnostic thresholds in the preoperative setting. Methods: We retrospectively analyzed 605 cervical lymph nodes from 393 preoperative DTC patients who underwent ultrasound-guided fine-needle aspiration (FNA) with concurrent FNA-Tg measurement (February 2019–April 2025). All lymph nodes had histopathological or cytological confirmation. Patients were stratified by anti-Tg status (>4.5 IU/mL). Receiver operating characteristic curve analysis determined optimal FNA-Tg cut-offs, and areas under the curve (AUCs) were compared using the DeLong test. Results: FNA-Tg demonstrated excellent overall diagnostic accuracy (AUC 0.963, 95% CI 0.946–0.980) with an optimal cut-off of 84.0 ng/mL (sensitivity 91.6%, specificity 95.3%). Anti-Tg-positive patients had significantly lower FNA-Tg levels in malignant lymph nodes compared to anti-Tg-negative patients (median 9872 vs. 22,327 ng/mL, p = 0.001). Subgroup analysis revealed superior performance in anti-Tg-negative patients (AUC 0.983, cut-off 84.4 ng/mL) compared to anti-Tg-positive patients (AUC 0.923, cut-off 65.7 ng/mL; p = 0.008). No significant correlation was observed between anti-Tg levels and FNA-Tg (ρ = −0.03, p = 0.501). Conclusions: Anti-Tg status influenced measured FNA-Tg levels and receiver operating characteristic (ROC) derived optimal thresholds in the preoperative setting. However, because malignant lymph nodes generally showed FNA-Tg values well above the benign range, the clinical impact of this difference appears limited in most clearly positive cases. These findings may still help refine interpretation in selected borderline cases. Full article

Background: The characterization of thyroid lesions is essential in clinical practice. Recent advances in imaging modalities, including nuclear imaging (NM), color Doppler ultrasonography, and sonography, have markedly improved the diagnostic accuracy for thyroid nodules. Objective: To assess thyroid diseases using Doppler ultrasound, nuclear scintigraphy, and sonography. Results: In this cross-sectional single-center study, 144 patients were examined to determine their thyroid structure and function using a multimodal imaging approach. Fine-needle aspiration cytology (FNAC) indicated that most thyroid nodules were benign (62.5%), with 37.5% being malignant. Doppler vascularity demonstrated a sensitivity of 70.4% and a specificity of 40% (AUC = 0.514) for malignancy detection, while scintigraphy uptake in hypofunctioning nodules (nodules with decreased radionuclide uptake) showed a sensitivity of 37% and a specificity of 54.4% (AUC = 0.388). Thyroxine hormone levels showed a sensitivity of 57.4% and a specificity of 45.6% (AUC = 0.503) for detecting malignant thyroid nodules. In multivariate logistic regression, increased Doppler vascularity remained an independent predictor of malignancy (OR = 2.39; 95% CI: 1.15–4.96; p = 0.019), whereas decreased scintigraphic uptake showed a borderline effect (OR = 1.82; p = 0.069); high T4 level and increased uptake were not significant predictors. The combined Doppler ultrasound, scintigraphy, and thyroxine level model yielded an AUC of 0.72 (95% CI: 0.63–0.81), markedly higher than any single parameter. At the optimal Youden threshold (0.43), the model achieved 79.6% sensitivity, 68.2% specificity, and 72.4% accuracy, highlighting the superior diagnostic performance of the integrated approach for pre-FNAC stratification of thyroid malignancies. There was a strong, significant linear association between thyroxine levels and thyroid scintigraphy uptake (p-value < 0.001). Most patients with normal thyroxine levels exhibited decreased uptake (66.1%), whereas a minority (6.5%) demonstrated elevated uptake levels. This study found a strong correlation between mixed-echogenicity nodules and thyroid scintigraphy uptake (p-value = 0.019). Mixed-echogenicity nodules were most often associated with reduced uptake (57.8%), and hypoechoic nodules often had normal uptake (57.1%). Conclusions: The complementary integration of color Doppler vascularity, Tc-99m thyroid scintigraphy, and serum thyroxine levels yields superior Doppler–scintigraphy uptake correlation, increases the overall diagnostic accuracy, and offers a practical, non-invasive algorithm for differentiating benign from malignant thyroid nodules prior to FNAC or surgery. Full article

This narrative review evaluates the current role of interventional radiology in the diagnosis and treatment of parathyroid disorders. In patients with biochemically confirmed hyperparathyroidism but inconclusive or discordant preoperative localization imaging, image-guided interventions can help establish a diagnosis that can alter management. This review outlines the current diagnostic and therapeutic modalities for the study of parathyroid pathology from the interventional radiologist’s perspective, highlighting novel techniques and their growing clinical adoption. The combination of ultrasound-guided fine-needle aspiration biopsy and measurement of parathyroid hormone (PTH) in the needle washout fluid can improve diagnostic specificity by providing biochemical evidence of parathyroid tissue. This is particularly useful for lesions that are difficult to differentiate from thyroid nodules or cervical lymph nodes based solely on imaging characteristics. Despite this, no widely accepted cut-off washout PTH level has yet been established. Due to the differences in assay techniques and laboratory procedures, results should be interpreted in conjunction with clinical findings and concomitant biochemical parameters. Ultrasound-guided thermal ablation techniques, especially radiofrequency and microwave ablation, have recently been reported as minimally invasive alternatives or adjuvants to surgery in appropriately selected patients. Evidence supporting parathyroid embolization is limited, but it may be considered a potential salvage option for persistent or recurrent disease. Given that most of the current evidence is derived from retrospective case series, multicenter prospective studies for technical standardization and long-term outcomes evaluation are clearly needed. Full article

Background: Endosonography (i.e., endoscopic ultrasound with bronchoscope fine-needle aspiration, EUS-B-FNA and endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA) is a widely used technique in the diagnosis and staging of non-small cell lung cancer. Limited data are available in diagnosing small cell lung cancer (SCLC), and no studies have specifically investigated the diagnostic accuracy of EUS-B-FNA in these patients. The study aims at evaluating the sensitivity and safety of endosonography in the diagnosis of SCLC. Methods: A prospective, single-center, observational study was conducted in Italy. All patients diagnosed with SCLC who underwent EUS-B-FNA and/or EBUS-TBNA were enrolled. The sensitivity of EUS-B-FNA and EBUS-TBNA were assessed using pathological confirmation as the gold standard. Results: A total of 72 patients (38 (53%) males) with confirmed SCLC were included in the study. EUS-B-FNA was performed in 31 (43%) patients and EBUS-TBNA in 44 (61.1%) patients; both procedures were performed in three (4.2%). The overall sensitivity of endosonography was 97.2%. The sensitivity of EUS-B-FNA and EBUS-TBNA was 96.8% and 90.9%, respectively. No differences were observed in the sensitivity of both techniques when sampling lymph nodes vs. pulmonary parenchymal lesions (p = 0.99). The overall complication rate was 5.6%. No major complications were reported. Conclusions: Endosonography is a highly accurate and safe technique in diagnosing SCLC. EUS-B-FNA alone demonstrates excellent sensitivity, supporting its extensive role as a valuable diagnostic tool. The combined use of both techniques may further optimize diagnostic yield in the diagnosis of SCLC. Full article

Background and Clinical Significance: Nodular fasciitis is a benign, self-limited myofibroblastic proliferation that frequently mimics malignant soft-tissue tumors both clinically and radiologically. Although it has been well described in the extremities, its uncommon occurrence in the submandibular region poses a diagnostic challenge. Case Presentation: We report the case of a 22-year-old male patient, presenting with a rapidly enlarging painless swelling in the left submandibular region. Ultrasound demonstrated a well-defined subcutaneous lesion, while magnetic resonance imaging revealed heterogeneous enhancement with diffusion restriction, suggesting inflammatory or neoplastic pathology. Fine-needle aspiration cytology showed spindle-cell proliferation with pseudosarcomatous features, warranting histological examination to exclude malignancy. Surgical resection was performed. Histopathological examination demonstrated a myofibroblastic proliferation with tissue culture-like morphology. Immunohistochemistry showed diffuse SMA positivity while many other immunohistological markers were negative, arguing against several histologic mimics. Fluorescence in situ hybridization confirmed USP6 gene rearrangement, establishing the diagnosis of nodular fasciitis. Conclusions: This case highlights the diagnostic challenges posed by nodular fasciitis in the head and neck region and emphasizes the importance of correlating imaging, cytology, histopathology, and molecular findings to avoid overtreatment. The literature review further supports the benign clinical course of this rare entity in the submandibular region and underscores the value of including it in the differential diagnosis of submandibular masses. Full article

Background: Artificial intelligence (AI) is increasingly applied in pulmonary endoscopy, including diagnostic bronchoscopy, interventional pulmonology and endobronchial imaging. Advances in computer vision, machine learning and robotic systems have expanded the potential for automated lesion detection, navigation to peripheral pulmonary lesions, and real-time procedural support. However, the current evidence base remains heterogeneous, and translational challenges persist. Methods: This review summarizes current applications and developments of AI across white-light bronchoscopy (WLB), image-enhanced bronchoscopy (e.g., narrow-band imaging and autofluorescence imaging), endobronchial ultrasound (EBUS), virtual and robotic bronchoscopies, and workflow optimization and training. The authors also examine the methodological limitations, regulatory considerations, and implementation barriers that affect translation into routine practice. Results: Reported developments include deep learning-based models for mucosal abnormality detection, lymph-node characterization during EBUS-guided transbronchial needle aspiration (EBUS-TBNA), improved lesion localization, and reduction in operator-dependent variability. Additionally, AI-assisted simulation platforms and decision-support tools are reshaping training paradigms. Nevertheless, most studies remain retrospective or single-center, with limited external validation, dataset heterogeneity, unclear model explainability, and incomplete integration into clinical workflows. Conclusions: AI has the potential to support lesion detection, navigation, and training in pulmonary endoscopy. However, robust prospective validation, standardized datasets, transparent model reporting, robust data governance, multidisciplinary collaboration, and careful integration into clinical practice are required before widespread adoption. Full article

Background and Objectives: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique widely used for mediastinal staging and diagnosis in patients with lung cancer and extrathoracic malignancies. This study aimed to evaluate patient and procedural factors associated with malignant histopathological outcomes in individuals undergoing EBUS-TBNA for intrathoracic lymphadenopathy across three malignancy groups: primary lung cancer, extrathoracic solid organ malignancy, and hematological malignancy. Materials and Methods: This retrospective descriptive study included patients who underwent EBUS-TBNA at Ankara Bilkent City Hospital between March 2019 and December 2023. Demographic characteristics, histopathological findings, procedural details, additional sampling techniques, and imaging parameters, including FDG SUVmax values from pre-procedural PET-CT, were recorded. Histopathological outcomes were categorized as malignant or non-malignant. Binary and multinomial logistic regression analyses were performed to identify independent predictors of malignancy and to differentiate between malignancy groups and lung cancer subtypes. Results: A total of 776 patients underwent EBUS-TBNA, and 667 were included after excluding non-diagnostic samples. Malignancy was detected in 274 patients, including primary lung cancer (n = 213, 77.7%), extrathoracic malignancy (n = 43, 15.7%), and hematological malignancy (n = 18, 6.6%). Of the included patients, 426 (63.9%) were male; the median age was 63 (IQR = 16) years. Older age (OR = 1.03, 95% CI = 1.02–1.05, p < 0.001), male sex (OR = 2.05, 95% CI = 1.43–2.93, p < 0.001), and larger lymph node size (OR = 1.09, 95% CI = 1.06–1.11, p < 0.001) were independently associated with malignant outcomes. Younger age, female sex, and smaller lymph node size were associated with extrathoracic malignancy compared to primary lung cancer, while younger age was the only predictor of hematological malignancy. Larger lymph node size was inversely associated with adenocarcinoma and squamous cell carcinoma compared with small cell lung cancer. Conclusions: Older age, male sex, and larger lymph node size independently predict malignant EBUS-TBNA outcomes. Younger age and female sex favor extrathoracic malignancy, whereas small cell lung cancer is associated with more extensive nodal involvement. Additional bronchoscopic techniques may enhance diagnostic accuracy in selected patients. Full article

Background: Fine-needle aspiration biopsy (FNAB) is the standard initial diagnostic procedure for thyroid nodules; however, a considerable proportion of results are non-diagnostic or indeterminate, often requiring repeat procedures and delaying management. Core needle biopsy (CNB) has been proposed as a second-line option. This study evaluated the frequency of non-conclusive FNAB and CNB results and assessed the diagnostic contribution of CNB in nodules with initially non-conclusive FNAB findings. Methods: A retrospective–prospective study was conducted between 2019 and 2025 at a tertiary referral center, including 434 thyroid nodules. Ultrasound risk stratification followed ACR TI-RADS criteria. FNAB was performed in 430 nodules, and CNB in 85 nodules, including 82 evaluated by both methods. Biopsy results were classified according to the Bethesda system as conclusive or non-conclusive. Paired comparisons were analyzed using the McNemar test, and associations with ultrasound risk were assessed. Results: FNAB produced non-conclusive results in 56.5% of cases, compared with 23.5% for CNB. In paired analysis, 53.7% of nodules with non-conclusive FNAB were reclassified as conclusive after CNB (p < 0.001). CNB significantly distinguished benign from malignant lesions, unlike FNAB. Hypoechogenicity, irregular margins, and punctate echogenic foci were independent predictors of malignancy. Minor complications were more frequent after CNB, while major complications were rare in both groups. Conclusions: CNB improves diagnostic yield when used as a second-line procedure in nodules with non-conclusive FNAB findings. Selective use in higher-risk nodules may reduce repeat procedures and facilitate more structured clinical management. Full article