Al Nofal Alaa, Gionfriddo Michael R, Javed Asma, Haydour Qusay, Brito Juan P, Prokop Larry J, Pittock Siobhan T, Murad Mohammad Hassan
Division of Paediatric Endocrinology, Mayo Clinic, Rochester, MN, USA.
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
Clin Endocrinol (Oxf). 2016 Mar;84(3):423-30. doi: 10.1111/cen.12786. Epub 2015 Apr 21.
Thyroid ultrasound (US) is a widely used tool for evaluating thyroid nodules. Various US features have been suggested as predictors of thyroid cancer in children.
To conduct a systematic review and meta-analysis to assess the diagnostic accuracy of different thyroid US features in detecting thyroid cancer in children.
We searched multiple online databases for cohort studies that enrolled paediatric patients with thyroid nodules (age <21 years) and evaluated the accuracy of 12 relevant ultrasound features. Diagnostic measures were pooled across studies using a random effects model.
The search strategy yielded 1199 citations, of which 12 studies met the predefined inclusion criteria (750 nodules). The prevalence of thyroid cancer was 27·2% (40·8% in patients with a history of radiation exposure and 23·2% in patients without a history of exposure to radiation). The most common cancer was papillary thyroid cancer (86·7%). The presence of internal calcifications and enlarged cervical lymph nodes were the US features with the highest likelihood ratio [4·46 (95% CI: 1·87-10·64) and 4·96 (95% CI: 2·01-12·24), respectively] for thyroid cancer. A cystic nodule was the feature with highest likelihood ratio for benign nodules [1·96 (95% CI: 0·87-4·43)].
Thyroid US features are not highly accurate predictors of benign or malignant aetiology of thyroid nodules in children. Internal calcification may predict malignancy, and cystic appearance may suggest benign aetiology.
甲状腺超声（US）是评估甲状腺结节广泛使用的工具。各种超声特征已被认为是儿童甲状腺癌的预测指标。
进行系统评价和荟萃分析，以评估不同甲状腺超声特征在检测儿童甲状腺癌中的诊断准确性。
我们在多个在线数据库中检索队列研究，这些研究纳入了患有甲状腺结节的儿科患者（年龄<21岁），并评估了12种相关超声特征的准确性。使用随机效应模型汇总各研究的诊断指标。
检索策略产生了1199条引文，其中12项研究符合预先定义的纳入标准（750个结节）。甲状腺癌的患病率为27.2%（有辐射暴露史的患者中为40.8%，无辐射暴露史的患者中为23.2%）。最常见的癌症是乳头状甲状腺癌（86.7%）。内部钙化和颈部淋巴结肿大是甲状腺癌可能性比最高的超声特征[分别为4.46（95%CI：1.87-10.64）和4.96（95%CI：2.01-12.24）]。囊性结节是良性结节可能性比最高的特征[1.96（95%CI：0.87-4.43）]。
甲状腺超声特征并非儿童甲状腺结节良性或恶性病因的高度准确预测指标。内部钙化可能预测恶性，而囊性表现可能提示良性病因。
