Diagnostic reliability of elastography in thyroid nodules reported as indeterminate at prior fine-needle aspiration cyto
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Diagnostic reliability of elastography in thyroid nodules reported as indeterminate at prior fine-needle aspiration cytology (FNAC): a systematic review and Bayesian meta-analysis Yuxuan Qiu 1 & Zhichao Xing 2 & Jingyan Liu 1 & Yulan Peng 1 & Jingqiang Zhu 2 & Anping Su 2 Received: 19 December 2019 / Revised: 6 May 2020 / Accepted: 9 June 2020 # European Society of Radiology 2020
Abstract Objectives To assess the diagnostic yields of elastography in thyroid nodules reported as indeterminate in FNAC according to guidelines. Methods Databases of Medline, Embase, and Cochrane Central were searched till 31 October 2019. Two different reviewers check the studies and extracted the data. The diagnostic accuracy and yield were quantitatively synthesized using Bayesian bivariate model in R. Results Twenty studies with 1734 indeterminate thyroid nodules undergoing elastography were included. The summary estimates of sensitivity and specificity were 0.766 (95% credible interval (CrI), 0.686–0.835) and 0.867 (95% CrI, 0.780–0.931), respectively. The summary estimate for diagnostic odds ratio (DOR) was 25.9 (95% CrI, 12.8–46.2). Summary receiver operating characteristic plots for elastography showed a right-diagonal curvilinear relationship, suggesting a trade-off between sensitivity and specificity, and the estimate of area under curve (AUC) was 0.743. The summary estimates for positive and negative likelihood ratios were 6.6 (95% CrI, 4.2–11.3) and 0.27 (95% CrI, 0.21–0.36), respectively. Conclusions Elastography had fair diagnostic yields in indeterminate thyroid nodules. Shear wave elastography and strain ratio elastography could be more efficient in diagnosis and should evolve in the next years while combing elastography with ultrasound would contribute more to sensitivity and specificity currently. Key Points • Elastography has fair diagnostic yields in indeterminate thyroid nodules. • Shear wave elastography and strain ratio elastography are more efficient than real-time elastography. • Combining elastography and other ultrasound techniques improves evaluation of indeterminate thyroid nodules. Keywords Thyroid nodule . Elastography . Cytological techniques . Meta-analysis
Yuxuan Qiu and Zhichao Xing contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07023-0) contains supplementary material, which is available to authorized users. * Anping Su [email protected] 1
Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People’s Republic of China
2
Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People’s Republic of China
Abbreviations AUC Area under the receiver operating characteristic curve DIC Deviance information criterion DOR Diagnostic odds ratio FNAC Fine-needle aspiration cytology MCMC Markov chain Monte Carlo NLR Negative likelihood ratio PLR Positive likelihood ratio
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