Abstract：
Background: The objective of this study is to evaluate the diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in detecting recurrence in patients with differentiated thyroid cancer (DTC) who have negative whole-body scans (WBSs) but elevated serum thyroglobulin (Tg) or thyroglobulin antibody (TgAb) levels. Methods: This systematic review/meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Diagnostic Test Accuracy criteria (International Prospective Register of Systematic Reviews registration number: CRD42022340924). A comprehensive search of the MEDLINE, EMBASE, and Cochrane databases identified articles reporting the diagnostic accuracy of FDG PET/CT for the detection of recurrence in patients with DTC with negative WBS and elevated serum Tg or TgAb levels published between January 2012 and June 2023. Meta-analyses were performed to determine the diagnostic accuracy of FDG PET/CT on the total target population as well as on subgroups stratified by serum Tg or TgAb, and thyrotropin (TSH) stimulation status at the time of FDG PET/CT. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was applied to evaluate the quality of evidence and the strength of recommendations to facilitate translation of the meta-analysis results into practical recommendations for clinical guidelines. Results: A total of 24 studies involving 1988 patients were included for analysis. The overall pooled sensitivity and specificity values were 0.87 (95% confidence interval [CI] = 0.83-0.92; I2 = 75%) and 0.84 (CI = 0.80-0.89; I2 = 44%), respectively. Subgroup analyses revealed no significant differences in the diagnostic accuracy of FDG PET/CT in patients stratified by serum Tg or TgAb levels, and TSH stimulation status at the time of PET/CT. Treatment plans were changed following FDG PET/CT imaging in 40% (CI = 34-47%; I2 = 39%) of cases. The quality level of evidence for using FDG PET/CT was moderate in both sensitivity and specificity according to the GRADE system. Conclusion: There is moderate quality evidence demonstrating the high diagnostic accuracy of FDG PET/CT in detecting recurrence in patients with DTC with negative WBS and elevated serum Tg or TgAb levels. This evidence corroborates the current guidelines\' endorsement of FDG PET/CT as a diagnostic tool in such patients.
摘要：
背景：这项研究的目的是评估18F-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDGPET/CT）在检测全身扫描（WBS）阴性但血清甲状腺球蛋白（Tg）或甲状腺球蛋白抗体（TgAb）水平升高的分化型甲状腺癌（DTC）患者复发的诊断准确性。
方法：本系统综述/荟萃分析按照诊断性测试准确性系统综述和荟萃分析（PRISMA-DTA）标准（PROSPERO注册号：CRD42022340924）的首选报告项目进行。全面搜索MEDLINE，EMBASE,Cochrane数据库确定了2012年1月至2023年6月发表的文章,报道了FDGPET/CT对WBS阴性且血清Tg或TgAb水平升高的DTC患者复发的诊断准确性.进行荟萃分析以确定FDGPET/CT对总目标人群以及通过血清Tg或TgAb分层的亚组的诊断准确性。FDGPET/CT时的促甲状腺激素刺激状态。建议的分级，评估,发展,和评估(GRADE)框架用于评估证据质量和建议强度,以促进荟萃分析结果转化为临床指南的实用建议.
结果：共纳入24项研究，涉及1,988例患者进行分析。总体合并敏感性和特异性值为0.87(95%置信区间[CI]，0.83-0.92;I2,75%)和0.84(95%CI，0.80-0.89;I2，44%)，分别。亚组分析显示，在按血清Tg或TgAb水平分层的患者中，FDGPET/CT的诊断准确性没有显着差异。PET/CT时的促甲状腺激素刺激状态。40%(95%CI,34%-47%;I2,39%)的病例在FDGPET/CT成像后改变了治疗计划。根据GRADE系统，使用FDGPET/CT的证据质量在敏感性和特异性上均中等。
结论：有中等质量的证据表明，FDGPET/CT在检测WBS阴性且血清Tg或TgAb水平升高的DTC患者的复发方面具有很高的诊断准确性。该证据证实了目前指南对FDGPET/CT作为此类患者的诊断工具的认可。
方法：本系统综述/荟萃分析按照诊断性测试准确性系统综述和荟萃分析（PRISMA-DTA）标准（PROSPERO注册号：CRD42022340924）的首选报告项目进行。全面搜索MEDLINE，EMBASE,Cochrane数据库确定了2012年1月至2023年6月发表的文章,报道了FDGPET/CT对WBS阴性且血清Tg或TgAb水平升高的DTC患者复发的诊断准确性.进行荟萃分析以确定FDGPET/CT对总目标人群以及通过血清Tg或TgAb分层的亚组的诊断准确性。FDGPET/CT时的促甲状腺激素刺激状态。建议的分级，评估,发展,和评估(GRADE)框架用于评估证据质量和建议强度,以促进荟萃分析结果转化为临床指南的实用建议.
结果：共纳入24项研究，涉及1,988例患者进行分析。总体合并敏感性和特异性值为0.87(95%置信区间[CI]，0.83-0.92;I2,75%)和0.84(95%CI，0.80-0.89;I2，44%)，分别。亚组分析显示，在按血清Tg或TgAb水平分层的患者中，FDGPET/CT的诊断准确性没有显着差异。PET/CT时的促甲状腺激素刺激状态。40%(95%CI,34%-47%;I2,39%)的病例在FDGPET/CT成像后改变了治疗计划。根据GRADE系统，使用FDGPET/CT的证据质量在敏感性和特异性上均中等。
结论：有中等质量的证据表明，FDGPET/CT在检测WBS阴性且血清Tg或TgAb水平升高的DTC患者的复发方面具有很高的诊断准确性。该证据证实了目前指南对FDGPET/CT作为此类患者的诊断工具的认可。
