Diagnostic performance of 99m Tc-MIBI scan in predicting the malignancy of thyroid nodules: a meta-analysis
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META-ANALYSIS
Diagnostic performance of 99mTc-MIBI scan in predicting the malignancy of thyroid nodules: a meta-analysis Giorgio Treglia • Carmelo Caldarella • Enrico Saggiorato • Luca Ceriani • Fabio Orlandi Massimo Salvatori • Luca Giovanella
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Received: 12 February 2013 / Accepted: 16 March 2013 / Published online: 26 March 2013 Ó Springer Science+Business Media New York 2013
Abstract Several studies have investigated the diagnostic performance of 99mTc-MIBI scan in the evaluation of thyroid nodules suspicious for malignancy with conflicting results. The aim of our study is to meta-analyze published data on this topic. A comprehensive literature search of studies published through December 2012 regarding the diagnostic performance of 99mTc-MIBI scan in the evaluation of thyroid nodules suspicious for malignancy was carried out. Pooled sensitivity and specificity of 99mTcMIBI scan on a per lesion-based analysis and the area under the ROC curve were calculated. Pathological reports of thyroid nodules were considered as reference standard. Twenty-one studies were included in the meta-analysis. Pooled sensitivity and specificity of 99mTc-MIBI scan in detecting malignant thyroid nodules were 85.1 % [95 % confidence interval (95 % CI): 81.1–88.5 %] and 45.7 % (95 % CI: 42.7–48.7 %), respectively, on a per lesionbased analysis, irrespective of eventual results of previous technetium pertechnetate (99mTcO4) or iodine-123 (123I) scan. The area under the ROC curve was 0.78. A sub-
Giorgio Treglia and Carmelo Caldarella equally contributed to this article sharing the first authorship. G. Treglia (&) L. Ceriani L. Giovanella Department of Nuclear Medicine, Oncology Institute of Southern Switzerland, via Ospedale 12, 6500 Bellinzona, Switzerland e-mail: [email protected] C. Caldarella M. Salvatori Institute of Nuclear Medicine, Catholic University of Rome, Rome, Italy E. Saggiorato F. Orlandi Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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analysis restricted to data on hypofunctioning nodules on TcO4 or 123I scans was performed: pooled sensitivity and specificity of 99mTc-MIBI scan in these nodules were 82.1 % (95 % CI: 77.2–86.3 %) and 62.8 % (95 % CI: 58.9–66.7 %), respectively, on a per lesion-based analysis. The area under the ROC curve was 0.81. 99mTc-MIBI scan is a sensitive diagnostic tool in predicting the malignancy of thyroid nodules. Therefore, this imaging method could be helpful in patients with thyroid nodules in which malignancy is suspected on the basis of conventional diagnostic techniques. Higher specificity can be reached when hypofunctioning thyroid nodules are considered. 99m
Keywords Meta-analysis MIBI Thyroid nodule Thyroid tumors Diagnostic performance
Introduction Thyroid nodules are a common and usually benign condition in the general population: palpable nodules can be found in 4–8 % of the adult population, with up to 68 % overall prevalence of nodular disease when high-frequency ultrasound detection is used [1, 2]. Prevalence of
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