Meta-analysis Of Ultrasound-guided Fine Needle Aspiration Cytology And Ultrasound Elastography In The Diagnosis Of Thyroid Nodules

Objective: The Meta-analysis method was used to evaluate and analyze the diagnostic value of ultrasound-guided fine needle aspiration cytology(US-FNAC)and ultrasound elastography(UE)to identify benign or malignant thyroid nodules from the perspective of evidence-based medicine.Methods: We systematically search the Chinese and English literatures on US-FNAC and UE diagnostic thyroid nodule,using postoperative pathological results as the gold standard,published before June 2019 in the databases of PubMed,Embase,Cochrane,CNKI,Wanfang and VIP.The literature was screened according to the method provided by the Cochrane Collaboration,and the required four-grid data was extracted,and the quality of the literature included in the study was evaluated by QUADAS-2(quality assessment of diagnostic accuracy studies-2).Meta-disc 1.4 and Stata14.0 software were used to analyze the heterogeneity of the literature.Meta-regression and sub-group analysiswere used to study the heterogeneity source.According to the heterogeneity test results,the corresponding model was selected by Stata14.0 software.Sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio were combined,and the summary receiver operating characteristic(SROC)curve was drawn to obtain the area under the curve(AUC)value,and finally US-FNAC and UE were used to evaluate and analyze the diagnostic value of benign or malignant thyroid nodules.Results: A total of seven studies(3 original studies published in English and 4 in Chinese)including 907 patients(1020 thyroid nodules,including 531 malignant nodules and 489 benign nodules.)were included in our Meta-analysis.Heterogeneity analysis indicated that there was significant heterogeneity in both methods.Meta-regression analysis was performed using the design,patient age,and average size of nodules as covariates.We found that the source of heterogeneity between UE studies was related to the design,and subgroup analysis was performed using the design.Meta-regression analysis of US-FNAC revealed no statistically significant differences between the sources of heterogeneity between studies and the covariates set above.We used the random effect model to combine the effects.The combined effects of US-FNAC and UE were as follows: the combined sensitivity(95%CI)was 0.77(0.59-0.89),0.84(0.73-0.91);the combined specificity(95%CI)was 0.85(0.70-0.93),0.69(0.39-0.89);the combined positive likelihood ratio(95%CI)was 5.23(2.62-10.45),2.70(1.07-6.83);the combined negative likelihood ratio(95%CI)was 0.27(0.15-0.48),0.24(0.10-0.55);the combined diagnostic odds ratio(95%CI)was 19.51(8.07-47.17),11.32(2.02-63.57);the area under the SROC curve(AUC)(95% CI)was 0.88(0.85-0.91),0.85(0.82-0.88).Conclusion: Both of US-FNAC and UE have a high diagnostic power for the differential diagnosis of benign or malignant thyroid nodules,and the diagnostic efficacy of US-FNAC is superior to UE.