系统评价纵横比大于1对不同大小甲状腺乳头状癌诊断价值的meta分析

发布时间：2018-10-12 15:10

【摘要】：研究背景:近年来甲状腺乳头状癌的发生率在世界范围内有所增加,尤其以甲状腺微小乳头状癌的增加为著,虽然甲状腺微小乳头状癌进展缓慢,甚至终身不出现临床症状,但是有极小部分被证实有侵袭性行为,并且有早期发生淋巴结及远处转移的报道,因此能够早期发现并诊断甲状腺乳头状癌具有十分重要的临床意义。有许多研究讨论了纵横比与甲状腺结节恶性风险的关系,并且有许多研究根据结节的大小分类,研究了纵横比在不同大小的结节中的诊断价值,但是这些研究的结论存在争议。目的:采用诊断性试验的meta分析的方法评估A/T1在不同大小的甲状腺乳头状癌的诊断价值,以期为临床工作中A/T1在诊断甲状腺乳头状癌中提供更可靠的依据。方法:计算机全面在线检索Pubmed和Embase两个数据库,查阅1990年1月至2016年12月期间发表的相关中英文文献。检索结束后,由两名评价员独立对所得文献严格执行纳入排除标准进行筛选,使用Meta-Disc 1.4软件完成纳入文献的Meta分析。结果:通过阅读纳入文献,最终得到了来自韩国和中国两个国家共8篇文献,均为回顾性研究。这些文献共包括病例数4778例,结节10mm的占24%(1150例),结节≤10mm的占78%(3628例)。Meta分析结果显示:A/T1在结节10mm和结节≤10mm诊断中的合并敏感性分别为0.38、0.65;合并特异性分别为0.93、0.80;合并阳性似然比分别为3.96、3.74;合并阴性似然比分别为0.75、0.38;合并诊断比值比分别为6.18、12.38,合并敏感度和特异度结果并计算SROC曲线下面积,A/T1在结节10mm诊断中的曲线下面积(AUC)为0.8165,在结节≤10mm诊断中的曲线下面积(AUC)为0.8394。结论:A/T1作为PTC的特征性超声诊断征象,A/T1对于诊断PTC≤10mm的特异性、敏感性以及准确度均比较高,对于PTC10mm其特异性和准确度均比较高,但是敏感度低,因此A/T1是诊断最大径≤10mm PTC可靠的超声特征性表现,可以作为主要的诊断标准,而A/T1不适宜作为最大直径10mm的PTC的主要诊断标准。
[Abstract]:Background: the incidence of thyroid papillary carcinoma has increased worldwide in recent years, especially the increase in thyroid micropapillary carcinoma, although the progression of thyroid micropapillary carcinoma is slow, even if it does not appear clinical symptoms for life. However, a very small number of thyroid papillary carcinomas have been confirmed to have aggressive behavior, and early occurrence of lymph nodes and distant metastasis has been reported, so it is of great clinical significance to detect and diagnose papillary thyroid carcinoma at an early stage. Many studies have discussed the relationship between aspect ratio and malignant risk of thyroid nodules, and many studies have studied the diagnostic value of aspect ratio in nodules of different sizes according to the size of nodules, but the conclusions of these studies are controversial. Objective: to evaluate the diagnostic value of A/T1 in different sizes of papillary thyroid carcinoma by meta analysis of diagnostic test, so as to provide a more reliable basis for the diagnosis of papillary thyroid carcinoma by A/T1 in clinical work. Methods: two databases, Pubmed and Embase, were searched online by computer and the relevant Chinese and English literatures published from January 1990 to December 2016 were consulted. At the end of the retrieval, two evaluators independently screened the inclusion exclusion criteria for strict implementation of the literature, and used Meta-Disc 1.4 software to complete the Meta analysis of the included documents. Results: 8 articles were collected from Korea and China, which were all retrospective studies. The literature includes 4778 cases. 24% (1150 cases) of nodular 10mm and 78% of nodular 鈮，

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