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(Medical Imaging Center, the First Affiliated Hospital ofJinan University， Guangzhou 510630， China)



Ultrasound-guided histology biopsy in diagnosis of benign and malignant thyroid nodules: Meta analysis

CHENLong,HUANGJiayi,MAPeiyan,ZHONGXing*

(MedicalImagingCenter,theFirstAffiliatedHospitalofJinanUniversity，Guangzhou510630，China)

Objective To evaluate the clinical value of ultrasound-guided histology biopsy in diagnosis of benign and malignant thyroid nodules with Meta analysis. Methods A comprehensive search in PubMed, China National Knowledge Infrastructure (CNKI) and Wanfang data was performed to identify relevant English and Chinese studieds about ultrasound-guided histology biopsy in diagnosis of benign and malignant thyroid nodules. The quality of the included studies was assessed using the QUADAS items. The Stata software (version 11.0) was used to merge sensitivity, specificity, positive likelihood radio, negative likelihood radio and diagnostic odds ratio. The summary receiver operating characteristic curve (SROC) was used for calculating the area under the curve (AUC). Results A total of 14 studies were collected. Meta analysis showed that the summary sensitivity and specificity was 0.96 (95%CI[0.93， 0.98]) and 0.98 (95%CI[0.96， 0.99])， respectively. And the summary positive likelihood radio, negative likelihood radio and diagnostic odds ratio was 47.78 (95%CI[26.53， 86.05])， 0.04 (95%CI[0.02， 0.07]) and 1 151.12 (95%CI[487.95，2 715.62])， respectively. The AUC of SROC curve was 0.99 (95%CI[0.98， 1.00]). Conclusion Ultrasound-guided histology biopsy has high sensitivity and specificity for diagnosing benign and malignant thyroid nodules.

Ultrasonography； Image-guided Biopsy； Thyroid nodule； Meta analysis

近年来，随着饮食及环境的变化，甲状腺疾病发生率明显增高[1]，甲状腺癌是内分泌系统最常见的恶性肿瘤，约占所有甲状腺结节的5%～15%[2-3]。随着近年来医疗技术的发展，甲状腺结节检出率逐渐提高，而对甲状腺疾病性质的诊断，目前临床仍主要依靠手术切除活检和超声引导下穿刺活检。手术切除活检为诊断甲状腺结节定性诊断的金标准，但因具有创伤大、费用高、耗时长等缺点，其临床应用受到一定的制约；甲状腺疾病诊治过程中，推荐首先采用超声引导下穿刺活检[4-5]。国外研究[6]报道，超声引导下穿刺活检对诊断甲状腺结节的性质，具有创伤小、费用低、耗时短、操作便捷等优点[6]。近年超声引导下穿刺活检技术得到快速发展，但其对疾病诊断的准确性值得探讨。本文通过Meta分析，在循证医学方面对超声引导下穿刺组织学活检甲状腺结节定性诊断的准确性进行分析与评估。

1 资料与方法

1.1文献来源 检索PubMed和中国国家知识基础设施(CNKI)文献库、万方数据库中的关于超声引导下穿刺活检诊断甲状腺结节的中文及英文文献。发表时间为2000年1月—2016年1月；中文检索词包括：“超声引导下穿刺”、“甲状腺肿块”、“甲状腺癌”、“手术病理”、“特异度”、“敏感度”，英文检索词包括：“ultrasound-guided needle biopsy”、“thyroid nodule”、“surgical pathology”、“specificity”、“sensitivity”。

1.2文献筛选 对相关参考文献进行筛选，纳入标准：①采用超声引导下穿刺活检诊断甲状腺结节良恶性;②样本量超过20例;③以手术病理为金标准,诊断明确;④有四格表数据或经计算可获四格表数据;⑤前瞻性研究。……