, Volume 53, Issue 3, pp 651–661 | Cite as

Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for thyroid malignancy: systematic review and meta-analysis

  • Naykky Singh Ospina
  • Juan P. Brito
  • Spyridoula Maraka
  • Ana E. Espinosa de Ycaza
  • Rene Rodriguez-Gutierrez
  • Michael R. Gionfriddo
  • Ana Castaneda-Guarderas
  • Khalid Benkhadra
  • Alaa Al Nofal
  • Patricia Erwin
  • John C. Morris
  • M. Regina Castro
  • Victor M. Montori



To systematically appraise and summarize the available evidence about the diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy (USFNA) for thyroid malignancy, and to explore the integration of these estimates with the probability of thyroid malignancy before USFNA.


A comprehensive search of multiple databases from each database’s inception to August 2014 was performed. Eligible studies included those that evaluated patients with thyroid nodules who underwent USFNA and subsequent evaluation by histopathology or long-term follow-up.


We identified 32 studies at moderate risk of bias evaluating the USFNA diagnostic characteristics for the diagnosis of thyroid malignancy. Results were imprecise and inconsistent across trials. The pooled likelihood ratio (LR) of thyroid malignancy for a benign USFNA result was 0.09 (95 % CI 0.06, 0.14; I 2 = 33 %), whereas the pooled LR for a malignant result was 197 (95 % CI, 68, 569; I 2 = 77 %). In the case of a suspicious for follicular neoplasm result, the pooled LR for malignancy was 0.6 (95 % CI, 0.4, 1.0; I 2 = 84 %) and 8.3 (95 % CI, 3.6, 19.2; I 2 = 89) for a result of suspicious for malignancy.


The available evidence regarding the diagnostic accuracy of USFNA warrants only limited confidence due to risk of bias, imprecision, and inconsistency. However, some USFNA results (benign, malignant) are likely very helpful, by significantly changing the pre-test probability of thyroid cancer.


Thyroid nodule Thyroid cancer Ultrasound-guided fine needle aspiration biopsy Diagnosis 



We would like to thank Choon-Chern (Mike) Lim for the development of the online calculator.

Authors’ contributions

NSO, JPB, SM, and VMM designed the study, served as overall principal investigators, and wrote and reviewed the manuscript. AEY, RRG, MRG, ACG, KB, AAN, PE, JM, RMC helped design the study, wrote, and made a critical review of the manuscript, and assisted in data collection. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interests

The authors have no conflict of interests.

Financial support

MRG was supported by CTSA Grant Number TL1 TR000137 from the National Center for Advancing Translational Science (NCATS). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

This publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.

Supplementary material

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Supplementary material 1 (DOCX 19 kb)
12020_2016_921_MOESM2_ESM.docx (13 kb)
Supplementary material 2 (DOCX 13 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Naykky Singh Ospina
    • 1
    • 2
  • Juan P. Brito
    • 1
    • 2
  • Spyridoula Maraka
    • 1
    • 2
  • Ana E. Espinosa de Ycaza
    • 1
  • Rene Rodriguez-Gutierrez
    • 2
  • Michael R. Gionfriddo
    • 2
    • 3
  • Ana Castaneda-Guarderas
    • 2
    • 4
  • Khalid Benkhadra
    • 2
    • 5
    • 6
  • Alaa Al Nofal
    • 7
  • Patricia Erwin
    • 8
  • John C. Morris
    • 1
  • M. Regina Castro
    • 1
  • Victor M. Montori
    • 1
    • 2
  1. 1.Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal MedicineMayo ClinicRochesterUSA
  2. 2.Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and NutritionMayo ClinicRochesterUSA
  3. 3.Mayo Graduate SchoolMayo ClinicRochesterUSA
  4. 4.Department of Emergency MedicineMayo ClinicRochesterUSA
  5. 5.Evidence-Based Practice Research ProgramMayo ClinicRochesterUSA
  6. 6.Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterUSA
  7. 7.Division of Pediatric EndocrinologyMayo ClinicRochesterUSA
  8. 8.Mayo Medical LibraryMayo ClinicRochesterUSA

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