Zulfa Putri O, Iqhrammullah Muhammad, Zufry Hendra
Medical Research Unit, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.
Faculty of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh, Indonesia.
Narra J. 2025 Apr;5(1):e1120. doi: 10.52225/narra.v5i1.1120. Epub 2025 Feb 25.
Controversy persists regarding the effectiveness of ultrasonography-guided fine-needle aspiration biopsy (US-FNAB) in distinguishing malignancies in large thyroid nodules. The prevailing belief that larger thyroid nodules inherently pose a higher risk of malignancy has led to a common practice of suggesting thyroidectomy for large thyroid nodules. Herein, the aim of this study was to assess the diagnostic accuracy of preoperative US-FNAB for distinguishing malignancy in large thyroid nodules. A search for published records was carried out on October 20, 2023, utilizing the search feature available on PubMed, Scopus, Embase, and Google Scholar. Patients with large thyroid nodules (3 cm or larger) who underwent preoperative US-FNAB and postoperative histopathological tests were included. Related outcomes, including false positive, false negative, true negative, true positive, specificity, and sensitivity, were extracted from each study. Pooled specificity and sensitivity were estimated, and the summarized receiver operating characteristic (sROC) curve, along with the summarized area under the curve (sAUC), was calculated. Out of 133 articles identified across four databases, ten studies with a total sample of 2752 patients were included. The overall diagnostic sensitivity was 72% (95%CI: 50-86%; =0.00) and specificity was 96% (95%CI: 87-90%; =0.00). The positive predictive value (PPV) and negative predictive value (NPV) were 93% (95%CI: 89-98%) and 75% (95%CI: 72-79%), respectively. sAUC was 93%, suggesting the diagnostic tool is accurate. Meta-regression analysis revealed that factors such as the number of samples, country (high-income vs upper-middle income), demographic characteristics (age and sex), and different thyroid size cut-off values did not significantly impact the sensitivity or specificity of US-FNAB. In conclusion, the present study confirms the reliability of US-FNAB in distinguishing malignancy in large thyroid nodules, emphasizing its role in reducing unnecessary thyroidectomy by identifying high-risk patients and challenging the conventional practice of routine thyroidectomy for large thyroid nodules.
关于超声引导下细针穿刺活检（US-FNAB）在鉴别大甲状腺结节恶性肿瘤方面的有效性，争议仍然存在。普遍认为较大的甲状腺结节本身具有更高的恶性风险，这导致了一种常见的做法，即建议对大甲状腺结节进行甲状腺切除术。在此，本研究的目的是评估术前US-FNAB鉴别大甲状腺结节恶性肿瘤的诊断准确性。2023年10月20日，利用PubMed、Scopus、Embase和谷歌学术上的搜索功能对已发表记录进行了检索。纳入了接受术前US-FNAB和术后组织病理学检查的大甲状腺结节（3厘米或更大）患者。从每项研究中提取相关结果，包括假阳性、假阴性、真阴性、真阳性、特异性和敏感性。估计合并特异性和敏感性，并计算汇总的受试者工作特征（sROC）曲线以及汇总曲线下面积（sAUC）。在四个数据库中识别出的133篇文章中，纳入了10项研究，总样本量为2752例患者。总体诊断敏感性为72%（95%CI：50-86%；P=0.00），特异性为96%（95%CI：87-90%；P=0.00）。阳性预测值（PPV）和阴性预测值（NPV）分别为93%（95%CI：89-98%）和75%（95%CI：72-79%）。sAUC为93%，表明该诊断工具准确。Meta回归分析显示，样本数量、国家（高收入与中高收入）、人口统计学特征（年龄和性别）以及不同的甲状腺大小临界值等因素对US-FNAB的敏感性或特异性没有显著影响。总之，本研究证实了US-FNAB在鉴别大甲状腺结节恶性肿瘤方面的可靠性，强调了其通过识别高危患者减少不必要甲状腺切除术的作用，并对大甲状腺结节常规甲状腺切除术的传统做法提出了挑战。
