Performance of Five Ultrasound Risk Stratification Systems in Selecting Thyroid Nodules for FNA
Performance of Five Ultrasound Risk Stratification Systems in Selecting Thyroid Nodules for FNA
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DOI：
10.1210/clinem/dgz170
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发表时间：
2020-05-01
影响因子：
5.8
通讯作者：
Trimboli, Pierpaolo
中科院分区：
文献类型：
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作者：
Castellana, Marco;Castellana, Carlo;Trimboli, Pierpaolo
语境。超声 (US) 风险分层系统 (RSS) 的开发旨在减少甲状腺结节患者不必要的细针抽吸手术 (FNA) 的次数。 目的。我们进行了系统回顾和荟萃分析，评估了 5 种最常见的美国 RSS 为 FNA 适当选择甲状腺结节的能力。数据源。该系统评价和荟萃分析已在 PROSPERO 上注册（CRD42019131771）。 PubMed、CENTRAL、Scopus 和 Web of Science 检索至 2019 年 3 月。研究选择。包括报告 AACE/ACE/AME、ACR TI-RADS、ATA、EU-TIRADS 和 K-TIRADS 性能数据的原始文章。数据提取。提取分类为真阴性、真阳性、假阴性和假阳性的结节数量。使用随机效应模型估计汇总操作点。还评估了观察者间的一致性。数据综合。纳入了 12 项评估 18 750 个甲状腺结节的研究。参与者是患有甲状腺结节并接受细针穿刺活检或空心针活检或手术并具有可用超声图像的成人门诊患者。恶性结节的最终诊断一般基于组织学，而良性结节则采用细胞学检查。诊断比值比 (DOR) 范围为 2.2 至 4.9。头对头比较显示，由于阳性结果的相对似然比较高，ACR-TIRADS 相对 ATA (P = .002) 或 K-TIRADS (P = .002) 的相对 DOR 更高。结论。目前的荟萃分析发现，ACR TI-RADS 在选择甲状腺结节进行 FNA 方面具有更高的性能。然而，对最常见的美国 RSS 的比较受到可用数据的限制。需要进一步的研究来证实这一发现。
Context. Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine-needle aspiration procedures (FNA) in patients with thyroid nodules.Objective. We conducted a systematic review and meta-analysis evaluating the ability of the 5 most common US RSSs for the appropriate selection of thyroid nodules for FNA.Data sources. This systematic review and meta-analysis was registered on PROSPERO (CRD42019131771). PubMed, CENTRAL, Scopus, and Web of Science were searched until March 2019.Study selection. Original articles reporting data on the performance of AACE/ACE/AME, ACR TI-RADS, ATA, EU-TIRADS, and K-TIRADS were included.Data extraction. The number of nodules classified as true negative, true positive, false negative, and false positive was extracted. Summary operating points were estimated using a random-effects model. Interobserver agreement was also assessed.Data synthesis. Twelve studies evaluating 18 750 thyroid nodules were included. Participants were adult outpatients with thyroid nodules submitted to either FNA or core-needle biopsy or surgery and with available US images. The final diagnosis for malignant nodules was generally based on histology, while cytology was used for benign nodules. Diagnostic odds ratio (DOR) ranged from 2.2 to 4.9. A head-to-head comparison showed a higher relative DOR for ACR-TIRADS versus ATA (P = .002) or K-TIRADS (P = .002), due to a higher relative likelihood ratio for positive results.Conclusions. The present meta-analysis found a higher performance of ACR TI-RADS in selecting thyroid nodules for FNA. However, the comparison across the most common US RSSs was limited by the data available. Further studies are needed to confirm this finding.