Department of Head and Neck Oncology, Mazumdar Shaw Medical Center, NH Health City, Bangalore, India.
Integrated Head and Neck Oncology Program, DSRG-5, Mazumdar Shaw Center for Translational Research, Mazumdar Shaw Medical Foundation, Bangalore, India.
Endocr Pathol. 2022 Jun;33(2):243-256. doi: 10.1007/s12022-022-09721-5. Epub 2022 May 21.
Conventional cytology-based diagnosis for thyroid cancer is limited with more than 30-45% of nodules categorized as indeterminate, necessitating surgery for confirming or refuting the diagnosis. This systematic review and meta-analysis were aimed at identifying immunocytochemical markers effective in delineating benign from malignant thyroid lesions in fine needle aspiration cytology (FNAC) samples, thereby improving the accuracy of cytology diagnosis. A systematic review of relevant articles (2000-2021) from online databases was carried out and the search protocol registered in PROSPERO database (CRD42021229121). The quality of studies was assessed using QUADAS-2. Review Manager 5.4.1 from Cochrane collaboration and MetaDisc Version 1.4 was used to conduct the meta-analysis. Bias in the studies were visually analyzed using funnel plots, and statistical significance was evaluated by Egger's test. Systematic review identified 64 original articles, while meta-analysis in eligible articles (n = 41) identified a panel of 5 markers, Galectin-3, HBME-1, CK-19, CD-56, and TPO. Assessment of the diagnostic performance revealed that Gal-3 (sensitivity: 0.81; CI: 0.79-0.83; specificity: 0.84; CI: 0.82-0.85) and HBME-1 (sensitivity: 0.83; Cl: 0.81-0.86; specificity: 0.85; CI: 0.83-0.86) showed high accuracy in delineating benign from malignant thyroid nodules. Efficacy analysis in indeterminate nodules showed Gal-3 and HBME-1 have high specificity of 0.86 (CI 0.84-0.89) and 0.82 (CI 0.78-0.86), respectively, and low sensitivity of 0.76 (CI 0.72-0.80) and 0.75 (CI 0.70-0.80), respectively. Diagnostic odds ratio (DOR) of Galectin-3 and HBME-1 were 39.18 (CI 23.38-65.65) and 24.44 (CI 11.16-53.54), respectively. Significant publication bias was observed for the markers Galectin-3 and CK-19 (p < 0.05). The panel of 5 markers identified from this meta-analysis are high-confidence candidates that need to be validated in thyroid cytology to establish their efficacy and enable clinical applicability.
基于传统细胞学的甲状腺癌诊断存在局限性，超过 30-45%的结节被归类为不确定，需要手术来确认或排除诊断。本系统评价和荟萃分析旨在确定在细针抽吸细胞学 (FNAC) 样本中有效区分良性和恶性甲状腺病变的免疫细胞化学标志物，从而提高细胞学诊断的准确性。对来自在线数据库的相关文章（2000-2021 年）进行了系统综述，并在 PROSPERO 数据库（CRD42021229121）中注册了搜索方案。使用 QUADAS-2 评估研究质量。来自 Cochrane 合作的 Review Manager 5.4.1 和 MetaDisc Version 1.4 用于进行荟萃分析。使用漏斗图直观分析研究中的偏倚，并使用 Egger 检验评估统计学意义。系统评价确定了 64 篇原始文章，而荟萃分析在合格的文章（n=41）中确定了一组 5 个标志物，Galectin-3、HBME-1、CK-19、CD-56 和 TPO。对诊断性能的评估表明，Gal-3（敏感性：0.81；CI：0.79-0.83；特异性：0.84；CI：0.82-0.85）和 HBME-1（敏感性：0.83；Cl：0.81-0.86；特异性：0.85；CI：0.83-0.86）在区分良性和恶性甲状腺结节方面具有较高的准确性。在不确定的结节中的功效分析表明，Gal-3 和 HBME-1 具有较高的特异性，分别为 0.86（CI 0.84-0.89）和 0.82（CI 0.78-0.86），以及较低的敏感性，分别为 0.76（CI 0.72-0.80）和 0.75（CI 0.70-0.80）。Galectin-3 和 HBME-1 的诊断比值比 (DOR) 分别为 39.18（CI 23.38-65.65）和 24.44（CI 11.16-53.54）。Galectin-3 和 CK-19 标志物观察到显著的发表偏倚（p<0.05）。本荟萃分析确定的 5 个标志物组合是高可信度的候选标志物，需要在甲状腺细胞学中进行验证，以确定其有效性并实现临床适用性。
