Suh Chong Hyun, Baek Jung Hwan, Lee Jeong Hyun, Choi Young Jun, Kim Kyung Won, Lee Jayoun, Chung Ki-Wook, Shong Young Kee
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.
Department of Radiology, Namwon Medical Center, 365 Chungjeong-Ro, Namwon-Si, Jeollabuk-Do, 590-702, Republic of Korea.
Endocrine. 2016 Nov;54(2):315-328. doi: 10.1007/s12020-016-0991-9. Epub 2016 May 25.
To evaluate the effectiveness and complications of core-needle biopsy (CNB) compared to fine-needle aspiration (FNA) for diagnosing thyroid malignancy. The Ovid-MEDLINE and EMBASE databases were searched for studies using CNB for diagnosing thyroid malignancy. A meta-analysis was performed to evaluate the diagnostic accuracy, the incidence of non-diagnostic, inconclusive results, and the complications of CNB and FNA. To overcome the heterogeneity, additional analyses based on three, homogeneous inclusion criteria were performed and subgroup analyses were performed. Twenty eligible studies of 4580 patients (4746 nodules) were included. Both CNB and FNA demonstrated a high sensitivity (91 %, 74 %, respectively; p = .053) and specificity (99 %, 100 %, respectively; p = .914). The area under the curve was larger in CNB (0.99) than in FNA (0.94). CNB demonstrated a significantly lower pooled proportion of non-diagnostic (5.5 %; p < .001) and inconclusive results (8.0 %; p < .001) than FNA (22.6 %, 40.2 %, respectively). The complications rate of FNA (0.0 %) was lower than that of CNB (0.01 %), although not significantly (p = .948). This meta-analysis showed variable heterogeneities, i.e., no heterogeneity to considerable heterogeneity. Additional meta-analyses based on three, homogeneous inclusion criteria demonstrated that heterogeneities were reduced, and the results are in agreement with those of all of the included studies. Subgroup analyses have explained the cause of heterogeneity across studies. Both CNB and FNA may be acceptable diagnostic tools for diagnosing thyroid malignancy. CNB may be a complementary diagnostic tool in nodules with initially non-diagnostic and indeterminate results on previous FNA.
评估粗针活检（CNB）与细针穿刺抽吸活检（FNA）相比在诊断甲状腺恶性肿瘤方面的有效性和并发症。检索Ovid-MEDLINE和EMBASE数据库中使用CNB诊断甲状腺恶性肿瘤的研究。进行荟萃分析以评估CNB和FNA的诊断准确性、非诊断性、不确定结果的发生率以及并发症。为克服异质性，基于三个同质纳入标准进行了额外分析并进行了亚组分析。纳入了20项符合条件的研究，共4580例患者（4746个结节）。CNB和FNA均显示出高敏感性（分别为91%、74%；p = 0.053）和特异性（分别为99%、100%；p = 0.914）。CNB的曲线下面积（0.99）大于FNA（0.94）。与FNA（分别为22.6%、40.2%）相比，CNB的非诊断性（5.5%；p < 0.001）和不确定结果的合并比例（8.0%；p < 0.001）显著更低。FNA的并发症发生率（0.0%）低于CNB（0.01%），尽管差异不显著（p = 0.948）。该荟萃分析显示了不同程度的异质性，即从无异质性到相当大的异质性。基于三个同质纳入标准的额外荟萃分析表明异质性降低，结果与所有纳入研究的结果一致。亚组分析解释了各研究间异质性的原因。CNB和FNA都可能是诊断甲状腺恶性肿瘤的可接受的诊断工具。对于先前FNA结果为初始非诊断性和不确定的结节，CNB可能是一种补充诊断工具。
