Ultrasonography,radionuclide Scintigraphy And Pro-tumor Imaging Radionuclide For Diagnosis Of Thyroid Nodules:A Meta- Analysis

Objective: The aim of this study was to evaluate diagnostic value of ultrasonography(US), Radionuclide scintigraphy(RS) and Pro-tumor imaging radionuclide(PIR)markers of malignancy of thyroid nodules with Meta analysis.Methods: Articles reporting US, RS and PIR data of patients with known or suspected thyroid cancers were searched in the Pub Med, EMBASE Ovid SP, CNKI, WANFANG and VIP databases up to November 2015. Study quality was assessed and data extraction were performed. The pooled sensitivity, specificity, diagnostic odds ratio and summary receiver operating characteristic curve were obtained from individual studies with a random effect model were calculated by the software of Meta-disc 1. 4, Review Manager 5.3 and STATA12.0. The extent and sources of heterogeneity were explored. Meta-regression, subgroup analyses, sensitivity analysis and the publication bias were also explored.Results: Twenty articles were included in this Meta-analysis. A total of 4679 nodules in 3794 patients(3463 benign tumors and 1216 malignant tumors) confirmed by pathology were analyzed. Significant heterogeneity was present. Meta-regression, subgroup analyses and the publication bias were recognized and controlled in the heterogeneity of Meta-analysis. The 99mTc-MIBI was selected in the heterogeneity of PIR by Meta-regression from possible factors such as country, design and nodule type. The affected factors of heterogeneity was not recognized in the US and RS. Sensitivity analysis shows that a paper which is poor stability, low confidence results, excluding the paper and remaining papers were analysised by meta-analysis in effect. The random effect model was used. For diagnosis, sensitivity, specificity, diagnostic odds ratio were respectively US 80%(95% confidence interval [CI] :0.78-0.83), 81%(95%CI:0.79-0.82), 18.52(95%CI:11.70-29.32). RS 64%(95%CI:0.59-0.69), 67%(95%CI:0.65-0.69),4.28(95%CI:2.56-7.16). PIR 77%(95%CI:0.74-0.81),83%(95%CI:0.80-0.85),15.61(95%CI:8.40-29.02). Area under curve(AUC)of Summary receive operating characteristic(SROC) curve were 0.8818, 0.7323, 0.8633 respectively. Besides, the AUC of combined diagnosis using US and RS together was 0.9310. Because US combined with PIR included less literature, can not be quantitatively calculate the area under the curve of their joint diagnosis, but the figure shows the qualitative analysis of both the area under the curve is closer to the upper left corner of the joint.Conclusoin: US and PIR in the differential diagnosis of benign and malignant thyroid nodules have high diagnostic value, the first choice is US, the two joint diagnostic efficiency is higher.