Wang Ying, Chen Menghan, Chen Peijun, Tong Jiahui, Zhang Ying, Yang Gaoyi
Department of Ultrasonography, School of Medicine, Hangzhou Normal University, Hangzhou, China.
Department of Ultrasonography, The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, China.
Gland Surg. 2022 Jul;11(7):1212-1223. doi: 10.21037/gs-22-347.
Currently, there is no evidence-based medical evidence for the diagnosis of lymph node metastasis (LNM) of thyroid cancer (TC) by ultrasound combined with computed tomography (US + CT), and the results of various studies on its diagnostic efficacy are inconsistent. Therefore, the diagnosis of cervical LNM by US + CT is controversial at present. The aims of the present systematic review and meta-analysis were to evaluate the diagnostic performance of US + CT in parallel for diagnosing cervical LNM in patients with TC.
We searched PubMed, EMBASE, Cochrane Library, Web of Science, and Wanfang Medical Network (Core journals only) for studies prior to May 2022 on the performance of US and CT in parallel for diagnosing cervical lymph nodes. The studies were screened according to inclusion and exclusion requirements, and the methodologic quality of the included studies was independently assessed by 2 reviewers using tailored questionnaires and criteria provided by Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). We calculated the sensitivity, specificity, and diagnostic odds ratio (DOR) of cervical LNM for the central region, lateral neck, and whole neck. Meta-regression was performed to determine which parameters caused high diagnostic heterogeneity.
We included 11 studies of 6,261 patients with TC and 8,394 non-TC patients were included in the study. Most of the risk assessments included in the study were low risk, with no high-risk items. For the parallel test of US + CT, pooled sensitivity and specificity in the central region and lateral neck were 0.73 [95% confidence interval (CI): 0.56-0.85] and 0.80 (95% CI: 0.72-0.85), respectively. The calculated positive likelihood ratio was 3.6 (95% CI: 2.9-4.4), negative likelihood ratio was 0.34 (95% CI: 0.20-0.56), and DOR was 11 (95% CI: 6-18). The area under the curve was 0.83. For US + CT, the pooled sensitivity and specificity in the central region and lateral neck were 0.73 (95% CI: 0.56-0.85) and 0.80 (95% CI: 0.72-0.85), respectively.
The diagnostic efficiency of CT for lateral cervical LNM is greater than for central cervical LNM. CT has high sensitivity and accuracy for the diagnosis of central cervical LNMs. US + CT is important for the preoperative examination of cervical LNMs in TC.
目前，尚无基于循证医学的证据支持超声联合计算机断层扫描（US + CT）用于诊断甲状腺癌（TC）的淋巴结转移（LNM），关于其诊断效能的各项研究结果并不一致。因此，目前US + CT诊断颈部LNM存在争议。本系统评价和荟萃分析的目的是评估US + CT并行诊断TC患者颈部LNM的诊断性能。
我们检索了PubMed、EMBASE、Cochrane图书馆、Web of Science和万方医学网（仅核心期刊），查找2022年5月之前关于US和CT并行诊断颈部淋巴结的研究。根据纳入和排除标准筛选研究，由2名评价者使用诊断准确性研究质量评估-2（QUADAS-2）提供的定制问卷和标准独立评估纳入研究的方法学质量。我们计算了颈部中央区域、侧颈部和整个颈部LNM的敏感性、特异性和诊断比值比（DOR）。进行Meta回归以确定哪些参数导致了高诊断异质性。
我们纳入了11项研究，共6261例TC患者，另有8394例非TC患者纳入研究。研究中纳入的大多数风险评估为低风险，无高风险项目。对于US + CT的并行检测，颈部中央区域和侧颈部的合并敏感性和特异性分别为0.73 [95%置信区间（CI）：0.56 - 0.85]和0.80（95% CI：0.72 - 0.85）。计算得出的阳性似然比为3.6（95% CI：2.9 - 4.4），阴性似然比为0.34（95% CI：0.20 - 0.56），DOR为11（95% CI：6 - 18）。曲线下面积为0.83。对于US + CT，颈部中央区域和侧颈部的合并敏感性和特异性分别为0.73（95% CI：0.56 - 0.85）和0.80（95% CI：0.72 - 0.85）。
CT对侧颈部LNM的诊断效率高于颈部中央区域LNM。CT对颈部中央区域LNM的诊断具有较高的敏感性和准确性。US + CT对TC患者颈部LNM的术前检查很重要。
