甲状腺结节的前后径与横径比值对其良恶性诊断价值的 Meta 分析
| 作者: |
1胡如英,
1莫文魁,
1杨晓霞,
1王国平,
1黄国强,
1黄一波
1 浙江中医药大学附属第二医院 普通外科，浙江 杭州 310005 |
| 通讯: |
黄一波
Email: 1175198034@qq.com |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2017.11.005 |
摘要
目的: 评价甲状腺结节的前后径与横径比值(A/T)≥ 1 对其良恶性的诊断价值。
方法: 检索多个国内外数据库，收集 2017 年 7 月前发表的有关评价甲状腺结节 A/T ≥ 1 对于恶性甲状 腺结节诊断价值的诊断性研究。按照纳入标准筛选文献、提取资料和质量评价后，用 Meta-Disc 1.4 统 计软件对数据进行分析。对纳入文献间的异质性进行评估，计算纳入研究中甲状腺结节 A/T ≥ 1 诊断 其为恶性的合并效应量，包括灵敏度、特异度、阳性似然比(PLR)、阴性似然比(NLR)、诊断比 值比(DOR)、综合受试者工作特征曲线下面积(AUC)与 Q* 指数;采用敏感性分析评估研究结果 的稳定性，并寻找研究间异质性来源。绘制 Deek 漏斗图评估研究结果所致的发表偏倚。
结果: 共纳入 13 篇研究，总计 11 243 枚结节，其中良性结节 9 227 枚，恶性结节 2 016 枚。13 篇 文献评估后质量高低不一，纳入研究间存在非阈值效应引起的异质性(r=0.352，P=0.239)。甲状腺 结节 A/T ≥ 1 诊断其为恶性的合并灵敏度为 0.31(95% CI=0.29~0.33)、特异度为 0.50(95% CI= 0.49~0.51)、PLR 为 1.32(95% CI=0.81~2.14)、NLR 为 0.85(95% CI=0.73~0.99)、DOR 为 1.51(95% CI= 0.77~2.90)、AUC 为 0.538 9、Q* 值为 0.529 2。纳入研究总体合并效应量结果稳定性好，异质性来 源可能为研究方法，种族差异，是否采用盲法等，Deek 漏斗图显示研究结果呈不对称分布，存在纳入 研究结果所致的发表偏倚。
结论: 甲状腺结节 A/T ≥ 1 对甲状腺结节的良恶性具有一定的诊断价值;但敏感度、特异度较低，需 结合其他影像学征象综合判断。
关键词：
甲状腺结节
诊断，鉴别
Meta 分析
方法: 检索多个国内外数据库，收集 2017 年 7 月前发表的有关评价甲状腺结节 A/T ≥ 1 对于恶性甲状 腺结节诊断价值的诊断性研究。按照纳入标准筛选文献、提取资料和质量评价后，用 Meta-Disc 1.4 统 计软件对数据进行分析。对纳入文献间的异质性进行评估，计算纳入研究中甲状腺结节 A/T ≥ 1 诊断 其为恶性的合并效应量，包括灵敏度、特异度、阳性似然比(PLR)、阴性似然比(NLR)、诊断比 值比(DOR)、综合受试者工作特征曲线下面积(AUC)与 Q* 指数;采用敏感性分析评估研究结果 的稳定性，并寻找研究间异质性来源。绘制 Deek 漏斗图评估研究结果所致的发表偏倚。
结果: 共纳入 13 篇研究，总计 11 243 枚结节，其中良性结节 9 227 枚，恶性结节 2 016 枚。13 篇 文献评估后质量高低不一，纳入研究间存在非阈值效应引起的异质性(r=0.352，P=0.239)。甲状腺 结节 A/T ≥ 1 诊断其为恶性的合并灵敏度为 0.31(95% CI=0.29~0.33)、特异度为 0.50(95% CI= 0.49~0.51)、PLR 为 1.32(95% CI=0.81~2.14)、NLR 为 0.85(95% CI=0.73~0.99)、DOR 为 1.51(95% CI= 0.77~2.90)、AUC 为 0.538 9、Q* 值为 0.529 2。纳入研究总体合并效应量结果稳定性好，异质性来 源可能为研究方法，种族差异，是否采用盲法等，Deek 漏斗图显示研究结果呈不对称分布，存在纳入 研究结果所致的发表偏倚。
结论: 甲状腺结节 A/T ≥ 1 对甲状腺结节的良恶性具有一定的诊断价值;但敏感度、特异度较低，需 结合其他影像学征象综合判断。
Value of anteroposterior to transverse diameter ratio of the thyroid nodule in diagnosis of its benign and malignant nature: a Meta-analysis
CorrespondingAuthor:Huang Yibo Email: 1175198034@qq.com
Abstract
Objective: To evaluate the value of anteroposterior to transverse diameter ratio (A/T) of the thyroid nodule greater than or equal to 1 in diagnosis of its benign and malignant nature.
Methods: e studies published before July 2017 evaluating the value of thyroid nodule’s A/T≥1 in diagnosis of malignant lesion were collected through searching several national and international databases. A er screening for inclusion criteria, data extraction and quality assessment, the data were analyzed with Meta-DiSc 1.4 statistical so ware. e heterogeneity among the included studies was assessed, and the pooled e ect estimates of thyroid nodule’s A/T≥1 in diagnosing its malignant nature in the included studies were calculated, which included the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), the area under the curve (AUC) of summary receive operating characteristic curve and Q* index. e stability of results of the overall pooled estimates of the included studies was validated by sensitivity analysis, and the sources of heterogeneity among the included studies were analyzed. e publication bias caused by the results of the included studies was evaluated by drawing the Deek’s funnel plot.
Results: A total of 13 studies were included, involving 11 243 nodules that included 9 227 benign nodules and 2 016 malignant nodules. e quality of 13 studies was uneven, and there was a heterogeneity caused by non- threshold e ect among the included studies (r=0.352, P=0.239). e overall pooled sensitivity, speci city, PLR, NLR, DOR, AUC and Q* index of the included studies of thyroid nodule’s A/T≥1 for diagnosing malignant nodule were 0.31 (95% CI=0.29–0.33), 0.50 (95% CI=0.49–0.51), 1.32 (95% CI=0.81–2.14), 0.85 (95% CI= 0.73–0.99), 1.51 (95% CI=0.77–2.90), 0.538 9 and 0.529 2, respectively. The results of the overall pooled estimates of included studies were stable, and the research methods, racial di erences and whether by blind design might be sources of the heterogeneity of the studies. e Deek’s funnel plot showed an asymmetrical distribution of the results, indicating that there was a publication bias caused by the results of the included studies.
Conclusion: yroid nodule’s A/T≥1 has certain value in di erential diagnosis of benign and malignant thyroid nodules. However, its sensitivity and specificity are low, so combined judgment with other imaging signs is necessary.
Keywords：
Thyroid Nodule
diagnosis
Di erential
diagnosis
Meta-Analysis
Methods: e studies published before July 2017 evaluating the value of thyroid nodule’s A/T≥1 in diagnosis of malignant lesion were collected through searching several national and international databases. A er screening for inclusion criteria, data extraction and quality assessment, the data were analyzed with Meta-DiSc 1.4 statistical so ware. e heterogeneity among the included studies was assessed, and the pooled e ect estimates of thyroid nodule’s A/T≥1 in diagnosing its malignant nature in the included studies were calculated, which included the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), the area under the curve (AUC) of summary receive operating characteristic curve and Q* index. e stability of results of the overall pooled estimates of the included studies was validated by sensitivity analysis, and the sources of heterogeneity among the included studies were analyzed. e publication bias caused by the results of the included studies was evaluated by drawing the Deek’s funnel plot.
Results: A total of 13 studies were included, involving 11 243 nodules that included 9 227 benign nodules and 2 016 malignant nodules. e quality of 13 studies was uneven, and there was a heterogeneity caused by non- threshold e ect among the included studies (r=0.352, P=0.239). e overall pooled sensitivity, speci city, PLR, NLR, DOR, AUC and Q* index of the included studies of thyroid nodule’s A/T≥1 for diagnosing malignant nodule were 0.31 (95% CI=0.29–0.33), 0.50 (95% CI=0.49–0.51), 1.32 (95% CI=0.81–2.14), 0.85 (95% CI= 0.73–0.99), 1.51 (95% CI=0.77–2.90), 0.538 9 and 0.529 2, respectively. The results of the overall pooled estimates of included studies were stable, and the research methods, racial di erences and whether by blind design might be sources of the heterogeneity of the studies. e Deek’s funnel plot showed an asymmetrical distribution of the results, indicating that there was a publication bias caused by the results of the included studies.
Conclusion: yroid nodule’s A/T≥1 has certain value in di erential diagnosis of benign and malignant thyroid nodules. However, its sensitivity and specificity are low, so combined judgment with other imaging signs is necessary.