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.
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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
- PRISMA:
-
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- QUADAS-2:
-
Quality Assessment of Diagnostic Accuracy Studies 2
- RD:
-
Risk difference
- RTE:
-
Real-time elastography
- SROC:
-
Summary receiver operating characteristic
- SWE:
-
Shear wave elastography
- US:
-
Ultrasound
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Funding
This systematic review and meta-analysis was supported by the 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University.
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The scientific guarantor of this publication is Dr. Yuxuan Qiu.
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Qiu, Y., Xing, Z., Liu, J. et al. Diagnostic reliability of elastography in thyroid nodules reported as indeterminate at prior fine-needle aspiration cytology (FNAC): a systematic review and Bayesian meta-analysis. Eur Radiol 30, 6624–6634 (2020). https://doi.org/10.1007/s00330-020-07023-0
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DOI: https://doi.org/10.1007/s00330-020-07023-0