常规超声与超声造影诊断甲状腺结节的Meta分析

Conventional and Contrast-enhanced Ultrasonography in Diagnosis of Thyroid Nodules:A Meta-analysis

目的超声造影(CEUS)鉴别诊断甲状腺良、恶性结节目前存在争议,本研究通过Meta分析评价CEUS对甲状腺结节的诊断价值。资料与方法在Pub Med数据库、中国知网、万方数据库中检索1990年1月—2014年12月以病理结果为"金标准"的关于常规超声、CEUS鉴别诊断甲状腺结节良恶性的中英文文献,对纳入文献进行质量评价。计算汇总敏感度、特异度及95%可信区间,并绘制汇总受试者工作特征曲线,得出Q*值。结果共纳入14篇1970个结节。常规超声、CEUS的汇总敏感度和汇总特异度分别为0.74、0.70和0.86、0.82。两者的汇总受试者工作特征曲线下面积分别为0.84、0.93,两者Q*值分别为0.77、0.86。结论 CEUS对甲状腺结节良恶性的鉴别诊断准确度较常规超声高,但两者对甲状腺结节的诊断均有重要意义,使甲状腺疾病患者避免不必要的手术治疗,对临床具有重要的诊断价值。

Purpose There is no agreement for contrast enhanced ultrasound （CEUS） in differential diagnosis of benign and malignant thyroid nodules. This paper aims to evaluate the diagnostic value of the conventional and contrast-enhanced ultrasonography in the diagnosis of thyroid nodule by meta analysis. Materials and Methods Literature search was performed in PubMed, CNKI and Wanfang databases to identify relevant English and Chinese literatures by using pathological results as the gold standard from January 1990 to September 2014. The quality of each selected study was evaluated by QUADAS. The pooled weighted sensitivity, specificity and the corresponding 95% CI were calculated. Summary receiver operating characteristic curves （SROC）, area under curve （AUC） and the Q＊ index were also calculated. Results A total of 14 literatures （1970 nodules） were included, the pooled weighted sensitivity and specificity of conventional ultrasonography were 0.74 and 0.70; those of contrast-enhanced ultrasonography were 0.86 and 0.82. The AUC by using the two methods were 0.84 and 0.93, respectively, and the Q＊ index were 0.77 and 0.86, respectively. Conclusion In the diagnosis of thyroid nodule, the accuracy of contrast-enhanced ultrasonography is better than conventional ultrasound; however, both of them have high clinical value in the diagnosis of thyroid nodule, thus they are helpful in avoidance of unnecessary surgical treatment in patients with thyroid disease.