Abstract：
OBJECTIVE: Conventional smear (CS) using fine-needle aspiration cytology (FNAC) has been established as the test of choice for diagnosing thyroid lesions, despite low sample adequacy and inter-individual variations. Although a liquid-based preparation (LBP) technique has been recently applied to overcome these limitations, its clinical utility and its accuracy over CS are controversial. This study aimed to determine the true sensitivity and specificity of LBP in thyroid FNAC by meta-analysis.
METHODS: Systematic review with meta-analysis.
METHODS: We searched major electronic databases (MEDLINE, EMBASE, Cochrane library, Google Scholar) with queries of \'thyroid\', \'LBP\' and \'liquid-based cytology\'. Original articles including cytohistologic correlation data comparing the accuracy of any LBP technique, such as ThinPrep, SurePath and Liqui-Prep, with CS were included for qualitative meta-analysis and preparation of synthesized reporter-operating curves (sROC).
RESULTS: A total of 372 studies were screened and 51 original articles were eligible for full-text review; finally, 24 studies were chosen for the meta-analysis. Average sample inadequacy was significantly lower in two mainstream LBP methods (ThinPrep and SurePath) than CS. Specificity and sensitivity by sROC were similar or slightly superior for LBP vs CS. Various cytomorphologic changes by each method have been reported.
CONCLUSIONS: Although a learning curve is essential for adapting to the cytomorphologic features of the LBP technique, our results support the use of two mainstream LBPs alone in thyroid FNAC that LBP will increase the sample adequacy and reduce the workload with similar accuracy. More data and further evaluation are needed for the other LBP methods.
METHODS: Systematic review with meta-analysis.
METHODS: We searched major electronic databases (MEDLINE, EMBASE, Cochrane library, Google Scholar) with queries of \'thyroid\', \'LBP\' and \'liquid-based cytology\'. Original articles including cytohistologic correlation data comparing the accuracy of any LBP technique, such as ThinPrep, SurePath and Liqui-Prep, with CS were included for qualitative meta-analysis and preparation of synthesized reporter-operating curves (sROC).
RESULTS: A total of 372 studies were screened and 51 original articles were eligible for full-text review; finally, 24 studies were chosen for the meta-analysis. Average sample inadequacy was significantly lower in two mainstream LBP methods (ThinPrep and SurePath) than CS. Specificity and sensitivity by sROC were similar or slightly superior for LBP vs CS. Various cytomorphologic changes by each method have been reported.
CONCLUSIONS: Although a learning curve is essential for adapting to the cytomorphologic features of the LBP technique, our results support the use of two mainstream LBPs alone in thyroid FNAC that LBP will increase the sample adequacy and reduce the workload with similar accuracy. More data and further evaluation are needed for the other LBP methods.
摘要：
目的：使用细针穿刺细胞学（FNAC）的常规涂片（CS）已被确定为诊断甲状腺病变的首选测试。尽管样本充足性低，个体间存在差异。尽管最近已经应用了基于液体的制备(LBP)技术来克服这些限制,其临床实用性及其相对于CS的准确性存在争议。本研究旨在通过荟萃分析确定LBP在甲状腺FNAC中的真正敏感性和特异性。
方法：系统评价与荟萃分析。
方法：我们搜索了主要的电子数据库(MEDLINE，EMBASE,科克伦图书馆,谷歌学者)带有“甲状腺”的查询，\'LBP\'和\'液基细胞学\'。原始文章，包括细胞组织学相关性数据，比较任何LBP技术的准确性，比如ThinPrep,SurePath和Liqui-Prep,纳入CS进行定性荟萃分析和合成报告-工作曲线(sROC)的制备.
结果：共筛选了372项研究，51篇原创文章符合全文审查条件；最后，选择了24项研究进行荟萃分析。两种主流LBP方法（ThinPrep和SurePath）的平均样本不足显着低于CS。LBP与CS的特异性和sROC敏感性相似或稍好。已经报道了每种方法的各种细胞形态学变化。
结论：尽管学习曲线对于适应LBP技术的细胞形态学特征至关重要，我们的结果支持在甲状腺FNAC中单独使用两种主流LBP,即LBP将以相似的准确度增加样本的充足性并减少工作量.其他LBP方法需要更多的数据和进一步的评估。
方法：系统评价与荟萃分析。
方法：我们搜索了主要的电子数据库(MEDLINE，EMBASE,科克伦图书馆,谷歌学者)带有“甲状腺”的查询，\'LBP\'和\'液基细胞学\'。原始文章，包括细胞组织学相关性数据，比较任何LBP技术的准确性，比如ThinPrep,SurePath和Liqui-Prep,纳入CS进行定性荟萃分析和合成报告-工作曲线(sROC)的制备.
结果：共筛选了372项研究，51篇原创文章符合全文审查条件；最后，选择了24项研究进行荟萃分析。两种主流LBP方法（ThinPrep和SurePath）的平均样本不足显着低于CS。LBP与CS的特异性和sROC敏感性相似或稍好。已经报道了每种方法的各种细胞形态学变化。
结论：尽管学习曲线对于适应LBP技术的细胞形态学特征至关重要，我们的结果支持在甲状腺FNAC中单独使用两种主流LBP,即LBP将以相似的准确度增加样本的充足性并减少工作量.其他LBP方法需要更多的数据和进一步的评估。
