The Accuracy of Thyroid Nodule Ultrasound to Predict Thyroid Cancer: Systematic Review and Meta-Analysis
The Accuracy of Thyroid Nodule Ultrasound to Predict Thyroid Cancer: Systematic Review and Meta-Analysis
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DOI：
10.1210/jc.2013-2928
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发表时间：
2014-04-01
影响因子：
5.8
通讯作者：
Montori, Victor M.
中科院分区：
文献类型：
--
作者：
Brito, Juan P.;Gionfriddo, Michael R.;Montori, Victor M.
背景：用于预测甲状腺结节恶性潜能的超声检查特征的诊断准确性仍然存在很大的不确定性。目的：本研究的目的是总结与甲状腺结节超声（US）预测甲状腺癌准确性相关的现有文献。方法：我们检索了多个数据库和参考文献列表，以进行队列研究，这些研究纳入了患有甲状腺结节的成年人，并报告了超声检查的诊断措施。总共分析了 14 个相关的超声特征。结果：我们纳入了 1985 年至 2012 年间的 31 项研究（研究的结节数量 18 288 个；平均大小 15 毫米）。甲状腺癌的发病率为20%。最常见的癌症类型是甲状腺乳头状癌（84%）。恶性肿瘤诊断比值比最高的美国结节特征是高度大于宽度[11.14（95%置信区间6.6-18.9）]。相反，良性结节诊断比值比最高的超声结节特征是海绵状外观[12（95%置信区间0.61-234.3）]。研究之间的异质性很大。准确性的估计取决于医生解释超声的经验、癌症和结节的类型（不确定）以及参考标准的类型。在阈值模型中，海绵状外观和囊性结节是仅有的两个特征，如果存在，可以避免使用细针抽吸活检。结论：低到中等质量的证据表明，个体超声特征并不能准确预测甲状腺癌。然而，囊性内容物和海绵状外观这两个特征可能预测良性结节，但由于它们很少发生，因此在临床实践中的适用性有限。
Context: Significant uncertainty remains surrounding the diagnostic accuracy of sonographic features used to predict the malignant potential of thyroid nodules.Objective: The objective of the study was to summarize the available literature related to the accuracy of thyroid nodule ultrasound (US) in the prediction of thyroid cancer.Methods: We searched multiple databases and reference lists for cohort studies that enrolled adults with thyroid nodules with reported diagnostic measures of sonography. A total of 14 relevant US features were analyzed.Results: We included 31 studies between 1985 and 2012 (number of nodules studied 18 288; average size 15 mm). The frequency of thyroid cancer was 20%. The most common type of cancer was papillary thyroid cancer (84%). The US nodule features with the highest diagnostic odds ratio for malignancy was being taller than wider [11.14 (95% confidence interval 6.6-18.9)]. Conversely, the US nodule features with the highest diagnostic odds ratio for benign nodules was spongiform appearance [12 (95% confidence interval 0.61-234.3)]. Heterogeneity across studies was substantial. Estimates of accuracy depended on the experience of the physician interpreting the US, the type of cancer and nodule (indeterminate), and type of reference standard. In a threshold model, spongiform appearance and cystic nodules were the only two features that, if present, could have avoided the use of fine-needle aspiration biopsy.Conclusions: Low- to moderate-quality evidence suggests that individual ultrasound features are not accurate predictors of thyroid cancer. Two features, cystic content and spongiform appearance, however, might predict benign nodules, but this has limited applicability to clinical practice due to their infrequent occurrence.