常规超声和弹性超声在诊断恶性甲状腺结节中的应用：系统评价和荟萃分析。

Conventional ultrasonography and elastosonography in diagnosis of malignant thyroid nodules: A systematic review and meta-analysis.

机构信息

Department of Ultrasound, Xiangcheng People's Hospital, Suzhou, Jiangsu, China.

出版信息

Front Endocrinol (Lausanne). 2023 Jan 6;13:1082881. doi: 10.3389/fendo.2022.1082881. eCollection 2022.

DOI:10.3389/fendo.2022.1082881

PMID:36686488

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9859672/

Abstract

PURPOSE

To evaluate the diagnostic value of conventional ultrasound and elastosonography in malignant thyroid nodules by meta-analysis.

METHODS

The literature included in the Cochrane Library, PubMed, and Embase were searched by using "elastosonography, ultrasonography, thyroid nodules" as the keywords. The clinical studies using elastosonography and conventional ultrasound to diagnose thyroid nodules were selected, and histopathology of thyroid nodules was used as reference standards. The quality evaluation and heterogeneity test were performed on the literature that met the requirements, the combined specificity and sensitivity were pooled, and a comprehensive ROC curve analysis was performed. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was utilized to evaluate the quality of each included study. Meta-DiSc version 1.4, StataSE 12 and Review Manager 5.4 were used.

RESULTS

A total of nine studies assessed 3066 thyroid nodules (2043 benign and 1023 malignant). The pooled sensitivity, specificity, PLR, NLR, and DOR of conventional ultrasound for the diagnose of malignant thyroid nodules were 0.833 (95% CI 0.809-0.855), 0.818 (95% CI 0.801-0.835), 4.85 (95% CI 4.36-5.39), 0.20 (95% CI 0.17-0.23), and 29.38 (95% CI 23.28-37.08), respectively, with an AUC of 0.9068. Also, the pooled sensitivity, specificity, PLR, NLR, and DOR of elastosonography were 0.774 (95% CI 0.741-0.804), 0.737 (95% CI 0.715-0.758), 3.14(95% CI 2.85-3.47), 0.29 (95% CI 0.25-0.34), and 9.35 (95% CI 7.63-11.46), respectively, with an AUC of 0.8801. Three studies provided data regarding the conventional ultrasound and elastosonography. The pooled sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.902 (95% CI 0.870-0.928), 0.649 (95% CI 0.616-0.681), 2.72 (95% CI 2.46-3.00), 0.14 (95% CI 0.11-0.19), 25.51 (95%CI 17.11-38.03), and 0.9294.

CONCLUSION

The existing evidence shows that elastosonography cannot completely replace conventional ultrasound in the diagnosis of malignant thyroid nodules, and the combination of elastosonography and conventional ultrasound gives a better diagnostic precision.

SYSTEMATIC REVIEW REGISTRATION

www.crd.york.ac.uk, identifier PROSPERO CRD42022375808.

摘要

目的

通过荟萃分析评估常规超声和超声弹性成像在诊断甲状腺恶性结节中的诊断价值。

方法

使用“超声弹性成像、超声、甲状腺结节”作为关键词，检索 Cochrane 图书馆、PubMed 和 Embase 中的文献。选择使用超声弹性成像和常规超声诊断甲状腺结节的临床研究，并以甲状腺结节的组织病理学为参考标准。对符合要求的文献进行质量评价和异质性检验，汇总合并特异性和敏感性，进行综合受试者工作特征曲线分析。使用 Quality Assessment of Diagnostic Accuracy Studies（QUADAS）工具评价每个纳入研究的质量。使用 Meta-DiSc 版本 1.4、StataSE 12 和 Review Manager 5.4。

结果

共纳入 9 项研究，评估了 3066 个甲状腺结节（2043 个良性和 1023 个恶性）。常规超声诊断甲状腺恶性结节的敏感性、特异性、阳性似然比、阴性似然比和诊断比值比分别为 0.833（95%置信区间 0.809-0.855）、0.818（95%置信区间 0.801-0.835）、4.85（95%置信区间 4.36-5.39）、0.20（95%置信区间 0.17-0.23）和 29.38（95%置信区间 23.28-37.08），曲线下面积为 0.9068。此外，超声弹性成像的敏感性、特异性、阳性似然比、阴性似然比和诊断比值比分别为 0.774（95%置信区间 0.741-0.804）、0.737（95%置信区间 0.715-0.758）、3.14（95%置信区间 2.85-3.47）、0.29（95%置信区间 0.25-0.34）和 9.35（95%置信区间 7.63-11.46），曲线下面积为 0.8801。有 3 项研究提供了常规超声和超声弹性成像的数据。合并的敏感性、特异性、阳性似然比、阴性似然比、诊断比值比和曲线下面积分别为 0.902（95%置信区间 0.870-0.928）、0.649（95%置信区间 0.616-0.681）、2.72（95%置信区间 2.46-3.00）、0.14（95%置信区间 0.11-0.19）、25.51（95%置信区间 17.11-38.03）和 0.9294。