Servizio di Endocrinologia e Diabetologia, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland.
Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland.
Endocrine. 2022 Oct;78(1):24-31. doi: 10.1007/s12020-022-03165-x. Epub 2022 Aug 20.
In the Italian system for reporting thyroid cytology (ICCRTC), nodules suspicious for (TIR4) and consistent with (TIR5) malignancy are thought being 5% and 4-8% of all biopsies and having risk of malignancy of 60-80% and >95%, respectively. However, no evidence-based data exist about these figures. The present systematic review aimed at achieving solid estimates about TIR4 and TIR5 also considering potential influencing factors.
The review was conducted according to MOOSE. Databases of Google Scholar and Cochrane were searched. No language restriction was used. The last search was performed on February 26th 2022. Quality assessment was performed. Proportion meta-analyses were performed using random-effect model. Statistical analyses were performed using OpenMeta [Analyst].
The online search retrieved 271 articles and 16 were finally included for quantitative analysis. The risk of bias was generally low. The pooled cancer prevalence in TIR4 was 92.5% (95%CI 89.4-95.6%) with unexplained moderate heterogeneity. The pooled cancer rate among TIR5 was 99.7% (95%CI 99.3-100%) without heterogeneity. The resection rate in TIR4 and TIR5 showed heterogeneity, being the latter explained when using their prevalence among biopsies: the higher the prevalence, the higher the operation rate. The pooled risk difference between TIR5 and TIR4 was significant (OR 11.153).
These figures can form the basis for the next updated version of ICCRTC. Any institution using ICCRTC should revise its series of TIR4/TIR5 to calculate the cancer rate, and, importantly, consider the modifiers of the risk of malignancy. A cross check among institutions is advised.
在意大利甲状腺细胞学报告系统（ICCRTC）中，可疑（TIR4）和一致（TIR5）恶性的结节被认为占所有活检的 5%和 4-8%，恶性风险分别为 60-80%和>95%。然而，目前尚无关于这些数据的循证证据。本系统评价旨在对 TIR4 和 TIR5 进行深入评估，同时考虑潜在的影响因素。
该研究按照 MOOSE 进行。检索了 Google Scholar 和 Cochrane 数据库，未对语言进行限制。最后一次搜索是在 2022 年 2 月 26 日进行的。使用随机效应模型进行比例荟萃分析。使用 OpenMeta [Analyst]进行统计分析。
在线搜索共检索到 271 篇文章，最终有 16 篇文章被纳入定量分析。偏倚风险普遍较低。TIR4 的癌症总患病率为 92.5%（95%CI 89.4-95.6%），存在无法解释的中度异质性。TIR5 的癌症患病率为 99.7%（95%CI 99.3-100%），无异质性。TIR4 和 TIR5 的切除率存在异质性，当使用活检中 TIR5 的患病率来解释时，异质性就会消失：患病率越高，手术率越高。TIR5 与 TIR4 之间的风险差异有统计学意义（OR 11.153）。
这些数据可以为 ICCRTC 的下一次更新版本提供依据。任何使用 ICCRTC 的机构都应该修改其 TIR4/TIR5 系列来计算癌症发生率，并且，重要的是，要考虑恶性风险的修饰因子。建议各机构之间进行交叉检查。
