比较核心针活检和重复细针穿刺活检对甲状腺结节的初步不确定结果：系统回顾、诊断准确性荟萃分析和荟萃回归。

Q2 Medicine

Journal of the American Society of Cytopathology Pub Date : 2024-12-27 DOI:10.1016/j.jasc.2024.12.006

Hendra Zufry MD, PhD , Timotius Ivan Hariyanto MD

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引用次数: 0

摘要

导读：细针穿刺活检（FNAB）不可诊断和不确定细胞学结果的比率相当高，导致反复穿刺和不必要的手术。本研究的主要目的是比较芯针活检（CNB）和重复FNAB对最初不确定（非诊断性和/或不确定意义的非典型性）FNAB结果的甲状腺结节的诊断准确性。材料与方法：结合相关关键词对Cochrane Library、Scopus、Europe PMC和Medline数据库进行全面检索，检索时间截止到2024年10月20日。本综述纳入了比较CNB和重复FNAB治疗甲状腺结节的文献。计算非诊断性和不确定的CNB和重复FNAB的合并优势比（OR）。利用双变量随机效应模型进行了一项荟萃分析，以评估两种活检方法对恶性肿瘤诊断的诊断准确性。结果：共纳入9项研究。我们的荟萃分析结果显示，非诊断性疾病的发生率较低(OR 0.12；95%可信区间[CI]: 0.06-0.23, P < 0.00001)，非典型性意义未定(OR 0.34；95%CI: 0.21-0.56, P < 0.0001)，不确定(OR 0.12；95%CI: 0.07-0.22, P < 0.00001) CNB与重复FNAB的结果。CNB的累积敏感性（75.1%）也明显优于重复FNAB(56.5%)，但累积特异性在CNB（99.9%）和重复FNAB（99.7%）之间没有显着差异。接受CNB或重复FNAB的患者没有出现任何重大并发症。结论：我们的研究表明，CNB可以用于诊断以前FNAB不确定的甲状腺结节，而不是重复FNAB程序。

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Comparison of core-needle biopsy and repeat fine-needle aspiration biopsy for thyroid nodules with initially inconclusive findings: a systematic review, diagnostic accuracy meta-analysis, and meta-regression

Introduction

The rate of nondiagnostic and indeterminate cytology findings from fine-needle aspiration biopsy (FNAB) is quite high, resulting in repeated puncture and unnecessary surgery. The primary objective of this investigation is to compare diagnostic accuracy of core-needle biopsy (CNB) with repeat FNAB for thyroid nodules with initially inconclusive (nondiagnostic and/or atypia of undetermined significance) FNAB results.

Materials and methods

A thorough search was performed on the Cochrane Library, Scopus, Europe PMC, and Medline databases until October 20th, 2024, employing a combination of pertinent keywords. This review incorporates literature that examines the comparison between CNB and repeat FNAB for thyroid nodule. Pooled odds ratio (OR) of nondiagnostic and inconclusive findings of CNB and repeat FNAB were calculated. A meta-analysis was conducted to assess the diagnostic accuracy of both biopsy methods for malignancy diagnosis utilizing a bivariate random-effects model.

Results

A total of 9 studies were incorporated. The results of our meta-analysis indicated lower rate of nondiagnostic (OR 0.12; 95% confidence interval [CI]: 0.06-0.23, P < 0.00001), atypia of undetermined significance (OR 0.34; 95%CI: 0.21-0.56, P < 0.0001), and inconclusive (OR 0.12; 95%CI: 0.07-0.22, P < 0.00001) findings from CNB compared to repeat FNAB. CNB also exhibited markedly superior cumulative sensitivity estimates (75.1%) compared to repeat FNAB (56.5%), however cumulative specificity did not show a significant difference between CNB (99.9%) and repeat FNAB (99.7%). No patients who received CNB or repeat FNAB encountered any major complications.

Conclusions

Our study suggests that CNB can be employed to diagnose thyroid nodules that were previously inconclusive on FNAB, rather than repeating the FNAB procedure.

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