Abstract：
BACKGROUND: In the Italian system for reporting thyroid cytology (ICCRTC), nodules suspicious for (TIR4) and consistent with (TIR5) malignancy are thought being 5% and 4-8% of all biopsies and having risk of malignancy of 60-80% and >95%, respectively. However, no evidence-based data exist about these figures. The present systematic review aimed at achieving solid estimates about TIR4 and TIR5 also considering potential influencing factors.
METHODS: The review was conducted according to MOOSE. Databases of Google Scholar and Cochrane were searched. No language restriction was used. The last search was performed on February 26th 2022. Quality assessment was performed. Proportion meta-analyses were performed using random-effect model. Statistical analyses were performed using OpenMeta [Analyst].
RESULTS: The online search retrieved 271 articles and 16 were finally included for quantitative analysis. The risk of bias was generally low. The pooled cancer prevalence in TIR4 was 92.5% (95%CI 89.4-95.6%) with unexplained moderate heterogeneity. The pooled cancer rate among TIR5 was 99.7% (95%CI 99.3-100%) without heterogeneity. The resection rate in TIR4 and TIR5 showed heterogeneity, being the latter explained when using their prevalence among biopsies: the higher the prevalence, the higher the operation rate. The pooled risk difference between TIR5 and TIR4 was significant (OR 11.153).
CONCLUSIONS: These figures can form the basis for the next updated version of ICCRTC. Any institution using ICCRTC should revise its series of TIR4/TIR5 to calculate the cancer rate, and, importantly, consider the modifiers of the risk of malignancy. A cross check among institutions is advised.
METHODS: The review was conducted according to MOOSE. Databases of Google Scholar and Cochrane were searched. No language restriction was used. The last search was performed on February 26th 2022. Quality assessment was performed. Proportion meta-analyses were performed using random-effect model. Statistical analyses were performed using OpenMeta [Analyst].
RESULTS: The online search retrieved 271 articles and 16 were finally included for quantitative analysis. The risk of bias was generally low. The pooled cancer prevalence in TIR4 was 92.5% (95%CI 89.4-95.6%) with unexplained moderate heterogeneity. The pooled cancer rate among TIR5 was 99.7% (95%CI 99.3-100%) without heterogeneity. The resection rate in TIR4 and TIR5 showed heterogeneity, being the latter explained when using their prevalence among biopsies: the higher the prevalence, the higher the operation rate. The pooled risk difference between TIR5 and TIR4 was significant (OR 11.153).
CONCLUSIONS: These figures can form the basis for the next updated version of ICCRTC. Any institution using ICCRTC should revise its series of TIR4/TIR5 to calculate the cancer rate, and, importantly, consider the modifiers of the risk of malignancy. A cross check among institutions is advised.
摘要：
背景：在意大利甲状腺细胞学报告系统（ICCRTC）中，怀疑（TIR4）和符合（TIR5）恶性肿瘤的结节被认为是所有活检的5％和4-8％，有60-80％和>95％的恶性肿瘤的风险，分别。然而,关于这些数字，没有基于证据的数据。本系统综述旨在实现对TIR4和TIR5的可靠估计，同时考虑潜在的影响因素。
方法：按照MOOSE进行综述。搜索了GoogleScholar和Cochrane的数据库。没有使用语言限制。最后一次搜索是在2022年2月26日进行的。进行质量评估。使用随机效应模型进行比例荟萃分析。使用OpenMeta[Analyst]进行统计分析。
结果：在线搜索检索到271篇文章，最终纳入16篇进行定量分析。偏倚的风险普遍较低。TIR4的合并癌症患病率为92.5%（95CI89.4-95.6%），具有无法解释的中度异质性。TIR5的合并癌症率为99.7%（95CI99.3-100%），无异质性。TIR4和TIR5的切除率表现出异质性，后者在使用活检中的患病率时解释：患病率越高，操作率越高。TIR5和TIR4之间的合并风险差异显着（OR11.153）。
结论：这些数字可以构成ICCRTC下一个更新版本的基础。任何使用ICCRTC的机构都应修改其TIR4/TIR5系列以计算癌症发生率，and,重要的是,考虑恶性肿瘤风险的修饰。建议各机构之间进行交叉检查。
方法：按照MOOSE进行综述。搜索了GoogleScholar和Cochrane的数据库。没有使用语言限制。最后一次搜索是在2022年2月26日进行的。进行质量评估。使用随机效应模型进行比例荟萃分析。使用OpenMeta[Analyst]进行统计分析。
结果：在线搜索检索到271篇文章，最终纳入16篇进行定量分析。偏倚的风险普遍较低。TIR4的合并癌症患病率为92.5%（95CI89.4-95.6%），具有无法解释的中度异质性。TIR5的合并癌症率为99.7%（95CI99.3-100%），无异质性。TIR4和TIR5的切除率表现出异质性，后者在使用活检中的患病率时解释：患病率越高，操作率越高。TIR5和TIR4之间的合并风险差异显着（OR11.153）。
结论：这些数字可以构成ICCRTC下一个更新版本的基础。任何使用ICCRTC的机构都应修改其TIR4/TIR5系列以计算癌症发生率，and,重要的是,考虑恶性肿瘤风险的修饰。建议各机构之间进行交叉检查。
