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

Journal: Endocrine 2017;53(3):651-61

PMID: 27071659

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Abstract

PURPOSE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Address: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.; Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.; Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.; Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.; Mayo Graduate School, Mayo Clinic, Rochester, MN, USA.; Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.; Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.; Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.; Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN, USA.; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.; Division of Pediatric Endocrinology, Mayo Clinic, Rochester, MN, USA.; Mayo Medical Library, Mayo Clinic, Rochester, MN, USA.; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA. [email protected].; Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. [email protected].

DOI: 10.1007/s12020-016-0921-x

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MeSH Terms: Biopsy, Fine-Needle, Humans, Image-Guided Biopsy, Sensitivity and Specificity, Thyroid Gland, Thyroid Neoplasms, Ultrasonography, Interventional