Ultrasonography and Fine-Needle Aspiration in Indeterminate Thyroid Nodules: A Systematic Review of Diagnostic Test Accuracy

Phillip Staibano; David Forner; Christopher W Noel; Han Zhang; Michael Gupta; Eric Monteiro; Anna M Sawka; Jesse D Pasternak; David P Goldstein; John R de Almeida

doi:10.1002/lary.29778

Ultrasonography and Fine-Needle Aspiration in Indeterminate Thyroid Nodules: A Systematic Review of Diagnostic Test Accuracy

Laryngoscope. 2022 Jan;132(1):242-251. doi: 10.1002/lary.29778. Epub 2021 Aug 19.

Authors

Phillip Staibano¹, David Forner^{2

3}, Christopher W Noel^{1

3}, Han Zhang⁴, Michael Gupta⁴, Eric Monteiro⁵, Anna M Sawka^{6

7}, Jesse D Pasternak^{8

9}, David P Goldstein¹, John R de Almeida^{1

3}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.
² Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
³ Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada.
⁵ Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
⁶ Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁷ Division of Endocrinology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.
⁸ Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
⁹ Toronto General Hospital Research Institute, University Health Network and University of Toronto, Toronto, Ontario, Canada.

PMID: 34411290
DOI: 10.1002/lary.29778

Abstract

Objectives/hypothesis: Sonographic risk criteria may assist in further prognostication of indeterminate thyroid nodules (ITNs). Our aim was to determine whether sonographic criteria could further delineate the post-test probability of malignancy in ITNs.

Study design: Meta-analysis of diagnostic test accuracy.

Methods: A systematic review of Web of Science, MEDLINE, EMBASE, and CINAHL was performed from inception to April 15, 2021. Eligible studies included those which reported ultrasonographic evaluations with the American Thyroid Association (ATA) or the Thyroid Imaging Reporting and Data System (TIRADS) in adult patients with ITNs. ATA or TIRADS were scored as low (negative) or high (positive) malignancy risk using a previously validated binary classification. Primary outcomes included pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio for all sonographic criteria. Studies were appraised using Quality Assessment of Diagnostic Accuracy Studies and the data were pooled using bivariate random-effects models.

Results: Seventeen studies were included in the analysis. For Bethesda III, ATA had a specificity (0.90, 95% confidence interval (CI): 0.74-0.94), but a sensitivity of 0.52 (95% CI: 0.25-0.77). Conversely, K-TIRADS had the highest sensitivity (0.78, 95% CI: 0.62-0.89) with a specificity of 0.53 (95% CI: 0.31-0.74). Furthermore, American College of Radiology and EU TIRADS had specificities of 0.60 (95% CI: 0.36-0.80) and 0.81 (95% CI: 0.73-0.87) with sensitivities of 0.70 (95% CI: 0.37-0.90) and 0.38 (95% CI: 0.20-0.60), respectively. There were few studies with Bethesda IV nodules.

Conclusions: Though dependent on malignancy rates, Bethesda III nodules with low-suspicion TIRADS features may benefit from clinical observation, whereas nodules with high-suspicion ATA features may require molecular testing and/or surgery.

Level of evidence: NA Laryngoscope, 132:242-251, 2022.

Keywords: Thyroid cancer; fine-needle aspiration biopsy; meta-analysis; systematic review; thyroid nodules; ultrasonography.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Biopsy, Fine-Needle*
Humans
Sensitivity and Specificity
Thyroid Gland / diagnostic imaging
Thyroid Gland / pathology
Thyroid Nodule / diagnosis*
Thyroid Nodule / diagnostic imaging
Thyroid Nodule / pathology
Ultrasonography*