Unnecessary thyroid nodule biopsy rates under four ultrasound risk stratification systems: a systematic review and meta-
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Unnecessary thyroid nodule biopsy rates under four ultrasound risk stratification systems: a systematic review and meta-analysis Pyeong Hwa Kim 1 & Chong Hyun Suh 1 & Jung Hwan Baek 1 & Sae Rom Chung 1 & Young Jun Choi 1 & Jeong Hyun Lee 1 Received: 27 May 2020 / Revised: 27 August 2020 / Accepted: 6 October 2020 # European Society of Radiology 2020
Abstract Objectives To summarize and compare unnecessary biopsy rates and diagnostic performance in the examination of thyroid nodules according to four representative US-based risk stratification systems. Methods MEDLINE/PubMed and EMBASE databases were searched to identify original articles investigating unnecessary biopsy rates according to at least one of the following guidelines: ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS. The unnecessary biopsy rates for each risk stratification system were pooled using a random-effects model. Meta-regression analyses were performed to explore heterogeneity. Diagnostic odds ratios (DORs) for the appropriate selection of thyroid nodules for fineneedle aspiration were also pooled using a bivariate random-effects model. Results Eight articles including 13,092 thyroid nodules met the eligibility criteria and were included. The pooled unnecessary biopsy rates of ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS were 25% (95% CI, 22–29%), 51% (95% CI, 44–58%), 38% (95% CI, 16–66%), and 55% (95% CI, 42–67%), respectively. The pooled unnecessary biopsy rate of ACR-TIRADS was significantly lower than that of ATA (p < .001) and K-TIRADS (p < .001), and also lower than that of EU-TIRADS, but not reaching statistical significance (p = .087). The pooled DORs of ACR-TIRADS, ATA, and K-TIRADS were 5.9 (95% CI, 3.6– 9.6), 6.3 (95% CI, 4.5–8.8), and 4.5 (95% CI, 1.7–11.6), respectively, with the differences not being statistically significant. Conclusions ACR-TIRADS showed a lower unnecessary biopsy rate than the other risk stratification systems albeit DOR was comparable between ACR-TIRADS, ATA, and K-TIRADS. Future revisions of each system should be made by referring to ACR-TIRADS to reduce unnecessary biopsy rates. Key Points • The pooled unnecessary biopsy rates of ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS were 25% (95% CI, 22–29%), 51% (95% CI, 44–58%), 38% (95% CI, 16–66%), and 55% (95% CI, 42–67%), respectively. • The pooled unnecessary biopsy rate of ACR-TIRADS was significantly lower than that of ATA (p < .001) and K-TIRADS (p < .001). • The pooled DORs of ACR-TIRADS, ATA, and K-TIRADS were 5.9 (95% CI, 3.6–9.6), 6.3 (95% CI, 4.5–8.8), and 4.5 (95% CI, 1.7–11.6), respectively, with the differences not being statistically significant. Keywords Thyroid . Thyroid neoplasm . Ultrasonography . Biopsy . Meta-analysis
Abbreviations Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07384-6) contains supplementary material, which is available to authorized users. * Jung Hwan Baek [email protected] 1
Department of Radiology and Research Institute of Radiology, University of Ulsan College
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