Hurtado-Lopez Luis-Mauricio, Carrillo-Muñoz Alfredo, Zaldivar-Ramirez Felipe-Rafael, Basurto-Kuba Erich Otto Paul, Monroy-Lozano Blanca-Estela
Department of Surgery, Thyroid Clinic, Hospital General de Mexico, Mexico City 06720, Mexico.
Thyroid Clinic, General Surgery Service, Hospital General de Mexico, Mexico 06726, Mexico.
World J Methodol. 2022 May 20;12(3):148-163. doi: 10.5662/wjm.v12.i3.148.
This study evaluates the American Thyroid Association (ATA) ultrasound (US) classification system for the initial assessment of thyroid nodules to determine if it indeed facilitates clinical decision-making.
To perform a systematic review and meta-analysis of the diagnostic value of the ATA US classification system for the initial assessment of thyroid nodules.
In accordance with the PRISMA statement for diagnostic test accuracy, we selected articles that evaluated the 2015 ATA US pattern guidelines using a diagnostic gold standard. We analyzed these cases using traditional diagnostic parameters, as well as the threshold approach to clinical decision-making and decision curve analysis.
We reviewed 13 articles with 8445 thyroid nodules, which were classified according to 2015 ATA patterns. Of these, 46.62% were malignant. No cancer was found in any of the ATA benign pattern nodules. The Bayesian analysis post-test probability for cancer in each classification was: (1) Very-low suspicion, 0.85%; (2) Low, 2.6%; (3) Intermediate, 6.7%; and (4) High, 40.9%. The net benefit (NB), expressed as avoided interventions, indicated that the highest capacity to avoid unnecessary fine needle aspiration biopsy (FNAB) in the patterns that we studied was 42, 31, 35, and 43 of every 100 FNABs. The NB calculation for a probability threshold of 11% for each of the ATA suspicion patterns studied is less than that of performing FNAB on all nodules.
These three types of analysis have shown that only the ATA high-suspicion diagnostic pattern is clinically useful, in which case, FNAB should be performed. However, the curve decision analysis has demonstrated that using the ATA US risk patterns to decide which patients need FNAB does not provide a greater benefit than performing FNAB on all thyroid nodules. Therefore, it is likely that a better way to approach the assessment of thyroid nodules would be to perform FNAB on all non-cystic nodules, as the present analysis has shown the ATA risk patterns do not provide an adequate clinical decision-making framework.
本研究评估美国甲状腺协会（ATA）超声（US）分类系统在甲状腺结节初始评估中的应用，以确定其是否真的有助于临床决策。
对ATA US分类系统在甲状腺结节初始评估中的诊断价值进行系统评价和荟萃分析。
根据诊断试验准确性的PRISMA声明，我们选择了使用诊断金标准评估2015年ATA US模式指南的文章。我们使用传统诊断参数、临床决策阈值方法和决策曲线分析对这些病例进行分析。
我们回顾了13篇文章，共8445个甲状腺结节，这些结节根据2015年ATA模式进行分类。其中，46.62%为恶性。在任何ATA良性模式结节中均未发现癌症。每种分类中癌症的贝叶斯分析检验后概率为：（1）极低可疑，0.85%；（2）低，2.6%；（3）中等可疑，6.7%；（4）高可疑，40.9%。以避免的干预措施表示的净效益（NB）表明，在我们研究的模式中，每100次细针穿刺活检（FNAB）中避免不必要FNAB的最高能力分别为42、31、35和43次。对所研究的每种ATA可疑模式，概率阈值为11%时的NB计算结果低于对所有结节进行FNAB的结果。
这三种类型的分析表明，只有ATA高可疑诊断模式在临床上有用，在这种情况下应进行FNAB。然而，曲线决策分析表明，使用ATA US风险模式来决定哪些患者需要FNAB，并不比对所有甲状腺结节进行FNAB带来更大的益处。因此，对甲状腺结节进行评估的更好方法可能是对所有非囊性结节进行FNAB，因为目前的分析表明ATA风险模式不能提供充分的临床决策框架。
