常规超声及超声新技术对甲状腺结节诊断价值的Meta分析
|
摘要
目的采用Meta分析评价常规超声、弹性成像和超声造影对甲状腺结节良恶性的诊断价值。方法对Pub Med、Cochrane Library、Embase、中国知网(CNKI)、维普数据库、中国生物医学文献数据库(CBM)、万方数据库进行中、英文文献检索,检索时间为1990年1月~2017年12月。严格按照纳入及排除标准对文献进行筛选,并根据诊断性试验质量评价QUADAS量表对所纳入文献进行质量评分。运用Meta-Disc 1.4软件分析所纳入文献中不同诊断方法的合并灵敏度、特异度、阳性似然比、阴性似然比、诊断比值比(DOR)及绘制汇总受试者工作特征曲线(SROC),计算曲线下面积。结果共纳入17篇文献,三种诊断方法研究的甲状腺结节共2174个。常规超声诊断的合并敏感度为0.59[95%CI(0.55~0.62)],合并特异度为0.77[95%CI(0.74~0.79)],合并阳性似然比为2.33[95%CI(1.87~2.89)],合并阴性似然比为0.53[95%CI(0.43~0.65)],合并诊断比值比为4.70[95%CI(3.18~6.95)],SROC曲线下面积0.7459。弹性成像诊断的合并敏感度为0.84[95%CI(0.82~0.87)],合并特异性为0.86[95%CI(0.84~0.88)],合并阳性似然比为5.37[95%CI(0.16~9.12)],合并阴性似然比为0.20[95%CI(0.16~0.24)],合并诊断比值比为30.96[95%CI(19.87~48.26)],SROC曲线下面积0.9148。超声造影诊断的合并敏感度为0.85[95%CI(0.83~0.88)],合并特异性为0.87[95%CI(0.85~0.89)],合并阳性似然比为6.01[95%CI(4.30~8.41)],合并阴性似然比为0.20[95%CI(0.15~0.26)],合并诊断比值比为32.82[95%CI(18.83~57.21)],SROC曲线下面积0.9070。结论弹性成像和超声造影鉴别甲状腺结节良恶性的准确性比较高,而常规超声鉴别结节良恶性准确性一般。但三者对甲状腺结节的诊断都具有重要的意义。常规超声仍然是检测甲状腺结节和描述结节特征最理想的成像方式。弹性成像和超声造影判断甲状腺结节性质的价值较高,可以作为常规超声的补充诊断手段。
Objective To evaluate the clinical value of conventional ultrasound, elastography and contrast-enhanced ultrasound in diagnosis of benign and malignant thyroid nodules with Meta analysis. Methods From Janurary 1990 to December 2017, Pub Med, Cochrane Library, Embase, CNKI, VIP, CBM and Wanfang data were searched to include literatures, according to the inclusion and exclusion criteria of diagnostic research. QUADAS scale was used to evaluate the quality of the literature included. And Meta-Disc 1.4 software was used to merge sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and draw the summary receiver operating characteristic(SROC curve), and calculate the area under the curve. Results A total of 2174 nodules of 17 literatures studied by 3 diagnostic methods. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and the AUC of the conventional ultrasound were 0.59 [95% CI(0.55-0.62)], 0.77 [95% CI(0.74-0.79)], 2.33 [95% CI(1.87-2.89)],0.53 [95% CI(0.43-0.65)], 4.70 [95% CI(3.18-6.95)],0.7459, respectively. The pooled sensitivity, specificity,positive likelihood ratio, negative likelihood ratio and the AUC of elastography were 0.84 [95%CI(0.82-0.87)],0.86 [95%CI(0.84-0.88)], 5.37 [95%CI(0.16-9.12)], 0.20 [95%CI(0.16-0.24)], 30.96 [95%CI(19.87-48.26)], 0.9148,respectively. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and the AUC of contrast-enhanced ultrasound were 0.85 [95%CI(0.83-0.88)], 0.87 [95%CI(0.85-0.89)], 6.01 [95%CI(4.30-8.14)], 0.20[95%CI(0.15-0.26)], 32.82 [95%CI(18.83-57.21)], 0.9070, respectively. Conclusion The accuracy of elastography and contrast-enhanced ultrasonography in distinguishing benign from malignant thyroid nodules is relatively high, while the accuracy of benign and malignant nodules in conventional ultrasound is generally acceptable. However, all three have important implications for the diagnosis of thyroid nodules. Conventional ultrasound remains the most ideal imaging modality for detecting thyroid nodules and describing nodular features. Elastography and contrast-enhanced ultrasonography are valuable in determining the nature of thyroid nodules and can be used as a supplemental diagnostic tool for routine ultrasound.
Objective To evaluate the clinical value of conventional ultrasound, elastography and contrast-enhanced ultrasound in diagnosis of benign and malignant thyroid nodules with Meta analysis. Methods From Janurary 1990 to December 2017, Pub Med, Cochrane Library, Embase, CNKI, VIP, CBM and Wanfang data were searched to include literatures, according to the inclusion and exclusion criteria of diagnostic research. QUADAS scale was used to evaluate the quality of the literature included. And Meta-Disc 1.4 software was used to merge sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and draw the summary receiver operating characteristic(SROC curve), and calculate the area under the curve. Results A total of 2174 nodules of 17 literatures studied by 3 diagnostic methods. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and the AUC of the conventional ultrasound were 0.59 [95% CI(0.55-0.62)], 0.77 [95% CI(0.74-0.79)], 2.33 [95% CI(1.87-2.89)],0.53 [95% CI(0.43-0.65)], 4.70 [95% CI(3.18-6.95)],0.7459, respectively. The pooled sensitivity, specificity,positive likelihood ratio, negative likelihood ratio and the AUC of elastography were 0.84 [95%CI(0.82-0.87)],0.86 [95%CI(0.84-0.88)], 5.37 [95%CI(0.16-9.12)], 0.20 [95%CI(0.16-0.24)], 30.96 [95%CI(19.87-48.26)], 0.9148,respectively. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and the AUC of contrast-enhanced ultrasound were 0.85 [95%CI(0.83-0.88)], 0.87 [95%CI(0.85-0.89)], 6.01 [95%CI(4.30-8.14)], 0.20[95%CI(0.15-0.26)], 32.82 [95%CI(18.83-57.21)], 0.9070, respectively. Conclusion The accuracy of elastography and contrast-enhanced ultrasonography in distinguishing benign from malignant thyroid nodules is relatively high, while the accuracy of benign and malignant nodules in conventional ultrasound is generally acceptable. However, all three have important implications for the diagnosis of thyroid nodules. Conventional ultrasound remains the most ideal imaging modality for detecting thyroid nodules and describing nodular features. Elastography and contrast-enhanced ultrasonography are valuable in determining the nature of thyroid nodules and can be used as a supplemental diagnostic tool for routine ultrasound.
引文
[1]Pang T,Huang L,Deng Y,et al.Logistic regression analysis of conventional ultrasonography,strain elastosonography,and contrast-enhanced ultrasound characteristics for the differentiation of benign and malignant thyroid nodules[J].PLo S One,2017,12(12):e0188987.
[2]Chang YC,Lo WC,Liao LJ.Surgeon-performed ultrasound elastography in the evaluation of thyroid nodules[J].J Med Ultrasound,2014,22(3):145-151.
[3]Batawil N,Alkordy T.Ultrasonographic features associated with malignancy in cytologically indeterminate thyroid nodules[J].Eur J Surg Oncol,2014,40(2):182-186.
[4]Zhang YF,Xu HX,Yong H,et al.Virtual touch tissue quantification of acoustic radiation force impulse:a new ultrasound elastic imaging in the diagnosis of thyroid nodules[J].PLo S One,2012,7(11):e49094.
[5]Gharib H,Papini E,Paschke R,et al.American Association of Clinical Endocrinologists,Associazione Medici Endocrinologi,and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules:executive Summary of recommendations[J].J Endocrinol Invest,2010,33(5):287-291.
[6]Ophir J,Céspedes I,Ponnekanti H,et al.Elastography:a quantitative method for imaging the elasticity of biological tissues[J].Ultrason Imaging,1991,13(2):111-134.
[7]Chen M,Zhang K,Xu Y,et al.Shear wave elastography and contrast-enhanced ultrasonography in the diagnosis of thyroid malignant nodules[J].Mol Clin Oncol,2016,5(6):724-730.
[8]Deng J,Zhou P,Tian SM,et al.Comparison of diagnostic efficacy of contrast-enhanced ultrasound,acoustic radiation force impulse imaging,and their combined use in differentiating focal solid thyroid nodules[J].PLo S One,2014,9(3):e90674.
[9]Zhang YZ,Xu T,Gong HY,et al.Application of high-resolution ultrasound,real-time elastography,and contrastenhanced ultrasound in differentiating solid thyroid nodules[J].Medicine(Baltimore),2016,95(45):e5329.
[10]Giusti M,Orlandi D,Melle G,et al.Is there a real diagnostic impact of elastosonography and contrast-enhanced ultrasonography in the management of thyroid nodules?[J].J Zhejiang Univ Sci B,2013,14(3):195-206.
[11]Cantisani V,Consorti F,Guerrisi A,et al.Prospective comparative evaluation of quantitative-elastosonography(Qelastography)and contrast-enhanced ultrasound for the evaluation of thyroid nodules:preliminary experience[J].Eur J Radiol,2013,82(11):1892-1898.
[12]周琦,陆鑫,尚旭,等.多模式超声成像评分在甲状腺结节良恶性鉴别诊断中的应用[J].临床超声医学杂志,2017,19(3):155-158.
[13]李晶,杨敏芳,张羽,等.弹性成像联合超声造影技术对甲状腺结节的诊断价值[J].哈尔滨医科大学学报,2017,51(4):351-355.
[14]陈超男,钱林学,胡向东,等.常规超声及超声新技术诊断甲状腺结节的临床应用[J].中国医学装备,2016,13(12):41-44.
[15]李岩.常规超声、超声造影、超声弹性成像在诊断甲状腺结节中的价值比较[J].现代诊断与治疗,2015(20):4727-4728.
[16]李潜,王雁,刘媛祎,等.超声TI-RADS分级、弹性成像及超声造影鉴别甲状腺结节良恶性的诊断价值[J].医药论坛杂志,2015(1):80-83.
[17]王霞,张建刚,李君,等.超声造影与弹性成像诊断良恶性甲状腺结节的对比分析[J].中国肿瘤临床与康复,2015(5):599-602.
[18]林诗彬,张建辉,黄利,等.超声造影和超声弹性成像鉴别诊断甲状腺良恶性结节的价值[J].中国肿瘤临床,2012,39(11):792-795.
[19]梁霞,唐石初,程智,等.超声造影和超声弹性成像在甲状腺小结节鉴别诊断中的应用[J].中国医师杂志,2014,16(3):369-372.
[20]郇婕,苏磊,刘保娴,等.超声新技术在甲状腺良恶性结节诊断中的价值[J].中山大学学报:医学科学版,2014,35(6):889-896.
[21]张硕,王会芳,王淑文,等.超声弹性成像和超声造影在甲状腺良恶性结节中的诊断价值[J].海南医学,2016,27(15):2476-2479.
[22]李苗,刘娜,白亚莲,等.超声造影和超声弹性成像对甲状腺良恶性结节的鉴别诊断价值[J].临床超声医学杂志,2011,30(8):516-520.
[23]刘景萍,张秀芳,胡健,等.高频超声、弹性成像联合超声造影在甲状腺结节诊断中应用价值[J].海南医学,2017,28(13):2143-2146.
[24]Remonti LR,Kramer CK,Leit觔o CB,et al.Thyroid ultrasound features and risk of carcinoma:a systematic review and meta-analysis of observational studies[J].Thyroid,2015,25(5):538-550.
[25]Kim H,Kim JA,Son EJ,et al.Quantitative assessment of shear-wave ultrasound elastography in thyroid nodules:diagnostic performance for predicting malignancy[J].Eur Radiol,2013,23(9):2532-2537.
[26]Trimboli P,Guglielmi R,Monti S,et al.Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography:a prospective multicenter study[J].J Clin Endocrinol Metab,2012,97(12):4524-4530.
[2]Chang YC,Lo WC,Liao LJ.Surgeon-performed ultrasound elastography in the evaluation of thyroid nodules[J].J Med Ultrasound,2014,22(3):145-151.
[3]Batawil N,Alkordy T.Ultrasonographic features associated with malignancy in cytologically indeterminate thyroid nodules[J].Eur J Surg Oncol,2014,40(2):182-186.
[4]Zhang YF,Xu HX,Yong H,et al.Virtual touch tissue quantification of acoustic radiation force impulse:a new ultrasound elastic imaging in the diagnosis of thyroid nodules[J].PLo S One,2012,7(11):e49094.
[5]Gharib H,Papini E,Paschke R,et al.American Association of Clinical Endocrinologists,Associazione Medici Endocrinologi,and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules:executive Summary of recommendations[J].J Endocrinol Invest,2010,33(5):287-291.
[6]Ophir J,Céspedes I,Ponnekanti H,et al.Elastography:a quantitative method for imaging the elasticity of biological tissues[J].Ultrason Imaging,1991,13(2):111-134.
[7]Chen M,Zhang K,Xu Y,et al.Shear wave elastography and contrast-enhanced ultrasonography in the diagnosis of thyroid malignant nodules[J].Mol Clin Oncol,2016,5(6):724-730.
[8]Deng J,Zhou P,Tian SM,et al.Comparison of diagnostic efficacy of contrast-enhanced ultrasound,acoustic radiation force impulse imaging,and their combined use in differentiating focal solid thyroid nodules[J].PLo S One,2014,9(3):e90674.
[9]Zhang YZ,Xu T,Gong HY,et al.Application of high-resolution ultrasound,real-time elastography,and contrastenhanced ultrasound in differentiating solid thyroid nodules[J].Medicine(Baltimore),2016,95(45):e5329.
[10]Giusti M,Orlandi D,Melle G,et al.Is there a real diagnostic impact of elastosonography and contrast-enhanced ultrasonography in the management of thyroid nodules?[J].J Zhejiang Univ Sci B,2013,14(3):195-206.
[11]Cantisani V,Consorti F,Guerrisi A,et al.Prospective comparative evaluation of quantitative-elastosonography(Qelastography)and contrast-enhanced ultrasound for the evaluation of thyroid nodules:preliminary experience[J].Eur J Radiol,2013,82(11):1892-1898.
[12]周琦,陆鑫,尚旭,等.多模式超声成像评分在甲状腺结节良恶性鉴别诊断中的应用[J].临床超声医学杂志,2017,19(3):155-158.
[13]李晶,杨敏芳,张羽,等.弹性成像联合超声造影技术对甲状腺结节的诊断价值[J].哈尔滨医科大学学报,2017,51(4):351-355.
[14]陈超男,钱林学,胡向东,等.常规超声及超声新技术诊断甲状腺结节的临床应用[J].中国医学装备,2016,13(12):41-44.
[15]李岩.常规超声、超声造影、超声弹性成像在诊断甲状腺结节中的价值比较[J].现代诊断与治疗,2015(20):4727-4728.
[16]李潜,王雁,刘媛祎,等.超声TI-RADS分级、弹性成像及超声造影鉴别甲状腺结节良恶性的诊断价值[J].医药论坛杂志,2015(1):80-83.
[17]王霞,张建刚,李君,等.超声造影与弹性成像诊断良恶性甲状腺结节的对比分析[J].中国肿瘤临床与康复,2015(5):599-602.
[18]林诗彬,张建辉,黄利,等.超声造影和超声弹性成像鉴别诊断甲状腺良恶性结节的价值[J].中国肿瘤临床,2012,39(11):792-795.
[19]梁霞,唐石初,程智,等.超声造影和超声弹性成像在甲状腺小结节鉴别诊断中的应用[J].中国医师杂志,2014,16(3):369-372.
[20]郇婕,苏磊,刘保娴,等.超声新技术在甲状腺良恶性结节诊断中的价值[J].中山大学学报:医学科学版,2014,35(6):889-896.
[21]张硕,王会芳,王淑文,等.超声弹性成像和超声造影在甲状腺良恶性结节中的诊断价值[J].海南医学,2016,27(15):2476-2479.
[22]李苗,刘娜,白亚莲,等.超声造影和超声弹性成像对甲状腺良恶性结节的鉴别诊断价值[J].临床超声医学杂志,2011,30(8):516-520.
[23]刘景萍,张秀芳,胡健,等.高频超声、弹性成像联合超声造影在甲状腺结节诊断中应用价值[J].海南医学,2017,28(13):2143-2146.
[24]Remonti LR,Kramer CK,Leit觔o CB,et al.Thyroid ultrasound features and risk of carcinoma:a systematic review and meta-analysis of observational studies[J].Thyroid,2015,25(5):538-550.
[25]Kim H,Kim JA,Son EJ,et al.Quantitative assessment of shear-wave ultrasound elastography in thyroid nodules:diagnostic performance for predicting malignancy[J].Eur Radiol,2013,23(9):2532-2537.
[26]Trimboli P,Guglielmi R,Monti S,et al.Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography:a prospective multicenter study[J].J Clin Endocrinol Metab,2012,97(12):4524-4530.