Sun Jiasi, Cai Jingyu, Wang Xuemei
Department of Ultrasound, First Affiliated Hospital of China Medical University, 155 Nanjing N St, Heping District, 110001 Shenyang, Liaoning, China.
J Ultrasound Med. 2014 Mar;33(3):495-502. doi: 10.7863/ultra.33.3.495.
The clinical challenge of managing thyroid nodules nowadays is to diagnose the minority of malignant disease. Real-time ultrasound elastography, which can measure tissue elasticity, is used as a complement to conventional sonography for improving the diagnosis of thyroid tumors. There are 2 common criteria for evaluating an elastogram: the elasticity score and strain ratio. This meta-analysis was performed to expand on a previous meta-analysis to assess the diagnostic power of ultrasound elastography in differentiating benign and malignant thyroid nodules for elasticity score and strain ratio assessment.
The MEDLINE, EMBASE, PubMed, and Cochrane Library databases up to January 31, 2013, were searched. The pooled sensitivity, specificity, and summary receiver operating characteristic curve were obtained from individual studies with a random-effects model. The extent and sources of heterogeneity were explored.
A total of 5481 nodules in 4468 patients for elasticity score studies and 1063 nodules in 983 patients for strain ratio studies were analyzed. The overall mean sensitivity and specificity of ultrasound elastography for differentiation of thyroid nodules were 0.79 (95% confidence interval [CI], 0.77-0.81) and 0.77 (95% CI, 0.76-0.79) for elasticity score assessment and 0.85 (95% CI, 0.81-0.89) and 0.80 (95% CI, 0.77-0.83) for strain ratio assessment, respectively. The areas under the curve for the elasticity score and strain ratio were 0.8941 and 0.9285.
These results confirmed those obtained in the previous meta-analysis. Ultrasound elastography has high sensitivity and specificity for identification of thyroid nodules. It is a promising tool for reducing unnecessary fine-needle-aspiration biopsy.
当前甲状腺结节管理面临的临床挑战是诊断出少数恶性疾病。实时超声弹性成像可测量组织弹性，作为传统超声检查的补充手段，用于提高甲状腺肿瘤的诊断水平。评估弹性图有两种常见标准：弹性评分和应变比。本荟萃分析旨在扩展之前的荟萃分析，以评估超声弹性成像在通过弹性评分和应变比评估来鉴别甲状腺良恶性结节方面的诊断能力。
检索截至2013年1月31日的MEDLINE、EMBASE、PubMed和Cochrane图书馆数据库。采用随机效应模型从各项研究中获取合并敏感度、特异度及汇总接收器操作特征曲线。探讨异质性的程度和来源。
弹性评分研究分析了4468例患者的5481个结节，应变比研究分析了983例患者的1063个结节。超声弹性成像鉴别甲状腺结节的总体平均敏感度和特异度，弹性评分评估分别为0.79（95%置信区间[CI]，0.77 - 0.81）和0.77（95%CI，0.76 - 0.79），应变比评估分别为0.85（95%CI，0.81 - 0.89）和0.80（95%CI，0.77 - 0.83）。弹性评分和应变比的曲线下面积分别为0.8941和0.9285。
这些结果证实了之前荟萃分析的结果。超声弹性成像在识别甲状腺结节方面具有高敏感度和特异度。它是减少不必要细针穿刺活检的一种有前景的工具。
