超声有助于鉴别贝塞斯达Ⅲ类甲状腺结节：一项遵循PRISMA规范的系统评价和荟萃分析。
Ultrasound is helpful to differentiate Bethesda class III thyroid nodules: A PRISMA-compliant systematic review and meta-analysis.
作者信息
Gao Lu-Ying, Wang Ying, Jiang Yu-Xin, Yang Xiao, Liu Ru-Yu, Xi Xue-Hua, Zhu Shen-Ling, Zhao Rui-Na, Lai Xing-Jian, Zhang Xiao-Yan, Zhang Bo
机构信息
Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China.
出版信息
Medicine (Baltimore). 2017 Apr;96(16):e6564. doi: 10.1097/MD.0000000000006564.
BACKGROUND
Fine-needle aspiration (FNA) is the most dependable tool to triage thyroid nodules for medical or surgical management. However, Bethesda class III cytology, namely "follicular lesion of undetermined significance" (FLUS) or "atypia of undetermined significance" (AUS), is a major limitation of the US-FNA in assessing thyroid nodules. As the most important imaging method, ultrasound (US) has a high efficacy in diagnosing thyroid nodules. This meta-analysis aimed to assess the role of US in evaluating Bethesda class III thyroid nodules.
METHODS
With keywords "Undetermined Significance," "Bethesda Category III," "Bethesda system," "Cytological Subcategory," "AUS/FLUS," "Atypia of Undetermined Significance," and "Ultrasound/US," papers in PubMed, Cochrane Library, Medline, Web of Science, Embase, and Google Scholar from inception to December 2016 were searched. A meta-analysis of these trials was then performed for evaluating the diagnostic value of thyroid ultrasound in Bethesda Category III thyroid nodules.
RESULTS
Fourteen studies including 2405 nodules were analyzed. According to the criteria for US diagnosis of thyroid nodules in each article, with any one of suspicious features as indictors of malignancy, US had a pooled sensitivity of 0.75 (95% CI 0.72-0.78) and a pooled specificity of 0.48 (95% CI 0.45-0.50) in evaluating Bethesda Class III Nodules. The pooled diagnostic odds ratio was 10.92 (95% CI 6.04-19.74). The overall area under the curve was 0.84 and the Q* index was 0.77. With any 2 or 3 of US suspicious features as indictors of malignancy, the sensitivity and specificity were 0.77 (95% CI 0.71-0.83) and 0.54 (95% CI 0.51-0.58), 0.66 (95% CI 0.59-0.73) and 0.71 (95% CI 0.68-0.74), respectively.
CONCLUSIONS
US was helpful for differentiating benign and malignant Bethesda class III thyroid nodules, with the more suspicious features, the more likely to be malignant.
背景
细针穿刺抽吸活检（FNA）是对甲状腺结节进行医学或手术处理分类的最可靠工具。然而，贝塞斯达III类细胞学，即“意义未明的滤泡性病变”（FLUS）或“意义未明的非典型病变”（AUS），是超声引导下FNA评估甲状腺结节的一个主要局限性。作为最重要的影像学检查方法，超声（US）在诊断甲状腺结节方面具有很高的效能。本荟萃分析旨在评估超声在评估贝塞斯达III类甲状腺结节中的作用。
方法
使用关键词“意义未明”、“贝塞斯达III类”、“贝塞斯达系统”、“细胞学亚类”、“AUS/FLUS”、“意义未明的非典型病变”和“超声/US”，检索了PubMed、Cochrane图书馆、Medline、科学网、Embase和谷歌学术数据库中从建库至2016年12月的文献。然后对这些试验进行荟萃分析，以评估甲状腺超声在贝塞斯达III类甲状腺结节中的诊断价值。
结果
分析了14项研究，共2405个结节。根据各篇文章中甲状腺结节的超声诊断标准，以任何一项可疑特征作为恶性指标，超声评估贝塞斯达III类结节的合并敏感度为0.75（95%CI 0.72 - 0.78），合并特异度为0.48（95%CI 0.45 - 0.50）。合并诊断比值比为10.92（95%CI 6.04 - 19.74）。曲线下总面积为0.84，Q*指数为0.77。以任何2项或3项超声可疑特征作为恶性指标时，敏感度和特异度分别为0.77（95%CI 0.71 - 0.83）和0.54（95%CI 0.51 - 0.58）、0.66（95%CI 0.59 - 0.73）和0.71（95%CI 0.68 - 0.74）。
结论
超声有助于鉴别贝塞斯达III类甲状腺结节的良恶性，可疑特征越多，越可能为恶性。
Zotero 插件