Pierpaolo Trimboli1,2, Marco Castellana3, Camilla Virili4, Roald Flesland Havre5, Fabiano Bini6, Franco Marinozzi6, Ferdinando D'Ambrosio7, Francesco Giorgino3, Luca Giovanella1, Helmut Prosch8, Giorgio Grani9, Maija Radzina10, Vito Cantisani11. 1. Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland. 2. Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland. 3. Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy. 4. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. 5. Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Cancer Medicine, Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway. 6. Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Rome, Italy. 7. Department of Radiological Sciences, Policlinico Umberto I, Sapienza University, Rome, Italy. 8. Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Währingergürtel, Vienna, Austria. 9. Department of Translational and Precision Medicine, Sapienza University, Rome, Italy. 10. Diagnostic Radiology Institute Paula Stradina Clinical University Hospital, Radiology Research Laboratory, University of Latvia, Riga Stradins University, Riga, Latvia. 11. Department of Imaging Diagnostics, Policlinico Umberto I, University Sapienza, Rome, Italy. vito.cantisani@uniroma1.it.
Abstract
BACKGROUND: The present study was undertaken to systematically review the literature on the reliability of using contrast-enhanced ultrasound (CEUS) to assess thyroid nodules. To avoid the potential bias in studies using a cytological standard of reference, here we aimed to meta-analyze data from studies adopting histological diagnosis as the gold standard. METHODS: A comprehensive literature exploration of PubMed and Scopus was conducted. The search was updated until June 2018 and references of the retrieved articles screened. Only original articles reporting the histological follow-up of nodules previously undergone CEUS evaluation were eligible for inclusion. Pooled sensitivity, specificity, PPV, and NPV of CEUS were calculated by DerSimonian and Laird method (random-effects model). RESULTS: The literature search retrieved 1885 articles, and 14 were included for the study. There were Chinese, Italian, German, and Austrian authors. All studies used SonoVue. The overall number of reported nodules was 1515, of which 775 were classified as positive at CEUS and 740 as negative. Pooled sensitivity, specificity, PPV, and NPV of CEUS were 85% (95% CI 83-88), 82% (95% CI 77-87), 83% (95% CI 77-88), and 85% (95% CI 81-88), respectively. Moderate inconsistency was present for specificity and PPV. There was publication bias for sensitivity and NPV. CONCLUSIONS: CEUS reaches good performance in discriminating between malignant and benign thyroid lesions.
BACKGROUND: The present study was undertaken to systematically review the literature on the reliability of using contrast-enhanced ultrasound (CEUS) to assess thyroid nodules. To avoid the potential bias in studies using a cytological standard of reference, here we aimed to meta-analyze data from studies adopting histological diagnosis as the gold standard. METHODS: A comprehensive literature exploration of PubMed and Scopus was conducted. The search was updated until June 2018 and references of the retrieved articles screened. Only original articles reporting the histological follow-up of nodules previously undergone CEUS evaluation were eligible for inclusion. Pooled sensitivity, specificity, PPV, and NPV of CEUS were calculated by DerSimonian and Laird method (random-effects model). RESULTS: The literature search retrieved 1885 articles, and 14 were included for the study. There were Chinese, Italian, German, and Austrian authors. All studies used SonoVue. The overall number of reported nodules was 1515, of which 775 were classified as positive at CEUS and 740 as negative. Pooled sensitivity, specificity, PPV, and NPV of CEUS were 85% (95% CI 83-88), 82% (95% CI 77-87), 83% (95% CI 77-88), and 85% (95% CI 81-88), respectively. Moderate inconsistency was present for specificity and PPV. There was publication bias for sensitivity and NPV. CONCLUSIONS: CEUS reaches good performance in discriminating between malignant and benign thyroid lesions.
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