Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.
Front Endocrinol (Lausanne). 2021 Mar 19;12:624409. doi: 10.3389/fendo.2021.624409. eCollection 2021.
Ultrasonography (US) is one of the most important methods for the management of thyroid nodules, which can be classified as solid, partially cystic, or cystic by composition. The various Thyroid Imaging Reporting and Data System classifications pay more attention to solid nodules and have reported pertinent US features associated with malignancy. However, the likelihood of malignancy of partially cystic thyroid nodules (PCTNs) is 3.3-17.6%, and few studies have systematically discussed the value of US in differentiating such entities. Therefore, we deemed it necessary to perform a systematic evaluation of US features in recognizing malignant PCTNs. Our systematic review and meta-analysis aimed to assess the value of US features in predicting malignant PCTNs. We searched the PubMed/MEDLINE, Web of Science, and Cochrane Library databases to find studies that researched US features of PCTNs and that were published before June 2020. Review Manager 5.3 was used to summarize suspicious US features and calculate the sensitivity, specificity, and likelihood ratios. MetaDiSc 1.4 was used to estimate receiver operating characteristic curves and calculate areas under the curves (AUCs). Our review included eight studies with a total of 2,004 PCTNs. Seven features were considered to be associated with malignancy. High specificity (>0.9) was found in nodules with a taller-than-wide shape, those that were spiculated/microlobulated or with an ill-defined margin, those with microcalcification, and a non-smooth rim. Among US features, eccentric configuration, microcalcification, and marked or mild hypoechogenicity were more reliable in predicting malignancy (AUC: 0.9592, 0.8504, and 0.8092, respectively). After meta-analysis, we recommend combining PCTN US features including an eccentric internal solid portion, marked or mild hypoechogenicity, and presence of microcalcification to better identify malignant nodules. More studies are needed to explore and improve the diagnostic value of US in PCTNs.
超声检查（US）是甲状腺结节管理的最重要方法之一，可根据成分将其分为实性、部分囊性或囊性。各种甲状腺影像报告和数据系统分类更关注实性结节，并报告了与恶性肿瘤相关的相关 US 特征。然而，部分囊性甲状腺结节（PCTN）的恶性肿瘤发生率为 3.3-17.6%，很少有研究系统地讨论 US 在鉴别此类实体中的价值。因此，我们认为有必要对识别恶性 PCTN 的 US 特征进行系统评估。我们的系统评价和荟萃分析旨在评估 US 特征在预测恶性 PCTN 中的价值。我们检索了 PubMed/MEDLINE、Web of Science 和 Cochrane 图书馆数据库，以查找研究 PCTN 的 US 特征并于 2020 年 6 月之前发表的研究。使用 Review Manager 5.3 总结可疑 US 特征并计算敏感性、特异性和似然比。使用 MetaDiSc 1.4 估计受试者工作特征曲线并计算曲线下面积（AUC）。我们的综述包括八项研究，共涉及 2004 个 PCTN。有七个特征被认为与恶性肿瘤有关。发现结节呈高宽比、分叶状/微叶状或边界不清、微钙化、边缘不光滑等特征具有较高的特异性（>0.9）。在 US 特征中，偏心性、微钙化和明显或轻度低回声在预测恶性肿瘤方面更可靠（AUC：0.9592、0.8504 和 0.8092）。荟萃分析后，我们建议结合 PCTN US 特征，包括偏心性内部实性部分、明显或轻度低回声和微钙化，以更好地识别恶性结节。需要进一步研究来探索和提高 US 在 PCTN 中的诊断价值。
