Division of Pediatric General Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
J Pediatr Surg. 2009 Nov;44(11):2184-91. doi: 10.1016/j.jpedsurg.2009.07.022.
There is conflicting evidence in the current literature regarding the use of fine-needle aspiration (FNA) biopsy in the diagnosis of a thyroid nodule in the pediatric population. There are numerous studies that look at the sensitivity and specificity of this test with varying results. A meta-analysis will provide further insight into this topic.
Our objective was to investigate the diagnostic parameters of FNA biopsy in the diagnosis of a thyroid nodule in the pediatric population, specifically, to determine the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the test in differentiating malignant vs benign tumors.
We performed a literature search of Medline, Embase, and evidence based medicine (EBM) reviews for English studies that looked at FNA biopsy in thyroid nodules in the pediatric population, in which diagnostic values were present or could be calculated and where FNA results were compared to an acceptable reference standard. Two reviewers independently selected all abstracts, and from these, studies to review. Two reviewers also independently checked diagnostic values in the studies or calculated them from data available. A meta-analysis was performed, and pooled diagnostic test values were calculated using a random-effects, bivariate meta-regression model. Studies were also assessed for quality using the quality assessment for diagnostic accuracy studies tool.
Twelve studies were included for review. The quality of the studies in general was good. The pooled estimate of sensitivity and specificity were 94% (95% confidence interval [CI], 86%-100%) and 81% (95% CI, 72%-91%), respectively. Assuming 20% of nodules are malignant, the accuracy, PPV, and NPV were 83.6%, 55.3%, and 98.2%, respectively.
This meta-analysis provides good evidence that FNA biopsy of thyroid nodules is a sensitive test in the pediatric population and may be a useful tool for excluding malignancy in young patients. Future prospective studies are needed to evaluate this further.
目前的文献中对于在儿科人群中使用细针抽吸活检（FNA）诊断甲状腺结节存在相互矛盾的证据。有许多研究着眼于该测试的敏感性和特异性，结果各不相同。荟萃分析将进一步深入探讨这一主题。
我们的目的是调查 FNA 活检在儿科人群中诊断甲状腺结节的诊断参数，具体来说，确定该测试在区分良恶性肿瘤方面的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）。
我们对 Medline、Embase 和循证医学（EBM）综述进行了文献检索，以查找研究儿科人群中 FNA 活检对甲状腺结节的诊断价值的英文研究，其中存在或可以计算出诊断值，并且 FNA 结果与可接受的参考标准进行了比较。两位审稿人独立选择所有摘要，并从这些摘要中选择要进行回顾的研究。两位审稿人还独立检查了研究中的诊断值，或者根据可用数据计算了这些值。使用随机效应、双变量荟萃回归模型进行荟萃分析，并计算汇总诊断测试值。还使用诊断准确性研究工具评估了研究的质量。
共纳入 12 项研究进行综述。总体而言，研究的质量良好。敏感性和特异性的汇总估计值分别为 94%（95%置信区间 [CI]，86%-100%）和 81%（95% CI，72%-91%）。假设 20%的结节为恶性，准确性、PPV 和 NPV 分别为 83.6%、55.3%和 98.2%。
这项荟萃分析提供了良好的证据，表明 FNA 活检在儿科人群中是一种敏感的检测方法，可能是排除年轻患者恶性肿瘤的有用工具。需要进一步的前瞻性研究来评估这一点。
