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Diagnostic reliability of elastography in thyroid nodules reported as indeterminate at prior fine-needle aspiration cytology (FNAC): a systematic review and Bayesian meta-analysis

  • Ultrasound
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Abstract

Objectives

To assess the diagnostic yields of elastography in thyroid nodules reported as indeterminate in FNAC according to guidelines.

Methods

Databases of Medline, Embase, and Cochrane Central were searched till 31 October 2019. Two different reviewers check the studies and extracted the data. The diagnostic accuracy and yield were quantitatively synthesized using Bayesian bivariate model in R.

Results

Twenty studies with 1734 indeterminate thyroid nodules undergoing elastography were included. The summary estimates of sensitivity and specificity were 0.766 (95% credible interval (CrI), 0.686–0.835) and 0.867 (95% CrI, 0.780–0.931), respectively. The summary estimate for diagnostic odds ratio (DOR) was 25.9 (95% CrI, 12.8–46.2). Summary receiver operating characteristic plots for elastography showed a right-diagonal curvilinear relationship, suggesting a trade-off between sensitivity and specificity, and the estimate of area under curve (AUC) was 0.743. The summary estimates for positive and negative likelihood ratios were 6.6 (95% CrI, 4.2–11.3) and 0.27 (95% CrI, 0.21–0.36), respectively.

Conclusions

Elastography had fair diagnostic yields in indeterminate thyroid nodules. Shear wave elastography and strain ratio elastography could be more efficient in diagnosis and should evolve in the next years while combing elastography with ultrasound would contribute more to sensitivity and specificity currently.

Key Points

• Elastography has fair diagnostic yields in indeterminate thyroid nodules.

• Shear wave elastography and strain ratio elastography are more efficient than real-time elastography.

• Combining elastography and other ultrasound techniques improves evaluation of indeterminate thyroid nodules.

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

DIC:

Deviance information criterion

DOR:

Diagnostic odds ratio

FNAC:

Fine-needle aspiration cytology

MCMC:

Markov chain Monte Carlo

NLR:

Negative likelihood ratio

PLR:

Positive likelihood ratio

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies 2

RD:

Risk difference

RTE:

Real-time elastography

SROC:

Summary receiver operating characteristic

SWE:

Shear wave elastography

US:

Ultrasound

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Funding

This systematic review and meta-analysis was supported by the 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University.

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Author notes

  1. Yuxuan Qiu and Zhichao Xing contributed equally to this work.

Authors and Affiliations

  1. Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People’s Republic of China

    Yuxuan Qiu, Jingyan Liu & Yulan Peng

  2. Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People’s Republic of China

    Zhichao Xing, Jingqiang Zhu & Anping Su

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  1. Yuxuan Qiu
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Correspondence to Anping Su.

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The scientific guarantor of this publication is Dr. Yuxuan Qiu.

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The authors of this manuscript declare no conflicts of interest.

Statistics and biometry

Dr. Yuxuan Qiu was responsible for statistical analysis.

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Approval was not required because this meta-analysis was based on former studies.

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This meta-analysis was based on former studies, and the ethical approval was not required in this meta-analysis.

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Qiu, Y., Xing, Z., Liu, J. et al. Diagnostic reliability of elastography in thyroid nodules reported as indeterminate at prior fine-needle aspiration cytology (FNAC): a systematic review and Bayesian meta-analysis. Eur Radiol 30, 6624–6634 (2020). https://doi.org/10.1007/s00330-020-07023-0

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