Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.
University of Bari Aldo Moro, Bari, Italy.
J Clin Endocrinol Metab. 2020 May 1;105(5). doi: 10.1210/clinem/dgz170.
Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine-needle aspiration procedures (FNA) in patients with thyroid nodules.
We conducted a systematic review and meta-analysis evaluating the ability of the 5 most common US RSSs for the appropriate selection of thyroid nodules for FNA.
This systematic review and meta-analysis was registered on PROSPERO (CRD42019131771). PubMed, CENTRAL, Scopus, and Web of Science were searched until March 2019.
Original articles reporting data on the performance of AACE/ACE/AME, ACR TI-RADS, ATA, EU-TIRADS, and K-TIRADS were included.
The number of nodules classified as true negative, true positive, false negative, and false positive was extracted. Summary operating points were estimated using a random-effects model. Interobserver agreement was also assessed.
Twelve studies evaluating 18 750 thyroid nodules were included. Participants were adult outpatients with thyroid nodules submitted to either FNA or core-needle biopsy or surgery and with available US images. The final diagnosis for malignant nodules was generally based on histology, while cytology was used for benign nodules. Diagnostic odds ratio (DOR) ranged from 2.2 to 4.9. A head-to-head comparison showed a higher relative DOR for ACR-TIRADS versus ATA (P = .002) or K-TIRADS (P = .002), due to a higher relative likelihood ratio for positive results.
The present meta-analysis found a higher performance of ACR TI-RADS in selecting thyroid nodules for FNA. However, the comparison across the most common US RSSs was limited by the data available. Further studies are needed to confirm this finding.
超声（US）风险分层系统（RSS）的开发旨在减少甲状腺结节患者中不必要的细针抽吸程序（FNA）的数量。
我们进行了一项系统评价和荟萃分析，评估了 5 种最常见的 US RSS 对甲状腺结节进行 FNA 的适当选择的能力。
本系统评价和荟萃分析在 PROSPERO（CRD42019131771）上注册。检索了 PubMed、CENTRAL、Scopus 和 Web of Science，直到 2019 年 3 月。
纳入了报告 AACE/ACE/AME、ACR TI-RADS、ATA、EU-TIRADS 和 K-TIRADS 表现数据的原始文章。
提取了分类为真阴性、真阳性、假阴性和假阳性的结节数量。使用随机效应模型估计汇总工作点。还评估了观察者间一致性。
纳入了 12 项评估 18750 个甲状腺结节的研究。参与者为接受 FNA 或核心针活检或手术的成年门诊甲状腺结节患者，且具有可用的 US 图像。恶性结节的最终诊断通常基于组织学，而良性结节则使用细胞学。诊断比值比（DOR）范围为 2.2 至 4.9。对头对头比较显示，ACR-TIRADS 与 ATA（P =.002）或 K-TIRADS（P =.002）相比，阳性结果的相对 DOR 更高，这是由于阳性结果的相对似然比更高。
本荟萃分析发现 ACR TI-RADS 在选择甲状腺结节进行 FNA 方面表现更好。然而，由于可用数据的限制，对最常见的 US RSS 进行比较受到限制。需要进一步的研究来证实这一发现。
