Fine-Needle Aspiration Versus Core Needle Biopsy for Malignant Cervical Lymphadenopathy: A Meta-Analysis and Systematic Review.

Abstract

Objective: Cervical lymphadenopathy is a common presentation in Otolaryngology-Head and Neck Surgery, often requiring biopsy to exclude malignancy. Fine-needle aspiration (FNA) is the standard initial diagnostic tool; however, evidence from other anatomical sites suggests that core needle biopsy (CNB) may offer superior diagnostic performance. This systematic review aims to compare the diagnostic accuracy and safety of FNA versus CNB for adult cervical lymphadenopathy.

Data sources: PubMed, Embase, and Cochrane databases were systematically searched for studies published between 1995 and 2025 evaluating FNA versus CNB for adult cervical lymphadenopathy. Studies lacking extractable cervical lymphadenopathy data were excluded.

Review methods: Two investigators independently screened studies and extracted data on study characteristics and diagnostic performance. A meta-analysis was performed in Stata using a random-effects model, and a quality assessment was conducted using the QUADAS-2 criteria.

Results: Of 2523 abstracts identified, 6 studies met inclusion criteria, with 5 providing adequate data for meta-analysis (total n = 649 patients, 331 FNA, 318 CNB). Pooled sensitivity and specificity were higher for CNB (0.94 and 0.98, respectively) compared to FNA (0.72 and 0.96; P < .001). CNB was 1.32 times more sensitive than FNA in detecting malignancy (P < .001). Both techniques had low complication rates. Study heterogeneity was low to moderate, and risk of bias was similarly moderate.

Conclusion: CNB demonstrates significantly greater diagnostic accuracy than FNA in detecting malignant cervical lymphadenopathy without increased complication risk. While further studies are warranted, these findings support greater consideration of CNB as a first-line diagnostic test to minimize inconclusive results and diagnostic delays.