背景:诊断性肺叶切除术治疗滤泡性肿瘤(FN)具有挑战性。
目的:本荟萃分析调查了是否存在一个合适的尺寸截止值,用于推荐通过细针穿刺诊断为FN的甲状腺结节的手术。
方法:Ovid-Medline,EMBASE,科克伦,和KoreaMed数据库中的研究报告FN/可疑FN(FN/SFN)根据肿瘤大小的恶性率,使用搜索词“细针抽吸,“滤泡性肿瘤,“肺叶切除术,\"\"手术,“和”甲状腺切除术。
结果:纳入了14项观察性研究,包括2016年FN/SFN结节和术后病理报告,2项研究包括不同肿瘤大小的恶性率。根据大小,FN/SFN结节的合并恶性风险为:比值比(OR)2.29(95%CI,1.68-3.11),临界值为4厘米(9项研究),OR2.39(95%CI,1.45-3.95),临界值为3厘米(3项研究),和OR1.81(95%CI,0.94-3.50),临界值为2cm(5项研究)。然而,根据删除1项影响研究后的留一法荟萃分析,≥2cm的肿瘤也显示出更高的风险(OR2.43;95%CI,1.54~3.82).当通过汇总接受者工作特征(sROC)曲线评估每个截止尺寸时,4厘米的截止值显示曲线下的总面积最高(sAUC,0.645)与其他截止值(sAUC,0.58与2厘米,和0.62与3厘米),虽然没有显著差异。
结论:尽管恶性肿瘤的风险随着肿瘤大小的增加而增加,在所有大小的肿瘤中,风险仍然很显著,在BethesdaIV甲状腺结节的诊断性手术中,不建议将截止限值作为决策参数.
BACKGROUND: The decision on diagnostic lobectomy for follicular neoplasms (FN) is challenging.
OBJECTIVE: This meta-analysis investigates whether an appropriate size cutoff exists for recommending surgery for thyroid nodules diagnosed as FN by fine needle aspiration.
METHODS: The Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases were searched for studies reporting the malignancy rate of FN/suspicious for FN (FN/SFN) according to tumor size, using search terms \"fine needle aspiration,\" \"follicular neoplasm,\" \"lobectomy,\" \"surgery,\" and \"thyroidectomy.\"
RESULTS: Fourteen observational studies comprising 2016 FN/SFN nodules with postsurgical pathologic reports were included, and 2 studies included malignancy rates with various tumor sizes. The pooled malignancy risk of FN/SFN nodules according to size was: odds ratio (OR) 2.29 (95% CI, 1.68-3.11) with cutoff of 4 cm (9 studies), OR 2.39 (95% CI, 1.45-3.95) with cutoff of 3 cm (3 studies), and OR 1.81 (95% CI, 0.94-3.50) with cutoff of 2 cm (5 studies). However, tumors ≥2 cm also showed a higher risk (OR 2.43; 95% CI, 1.54-3.82) based on the leave-one-out meta-analysis after removal of 1 influence study. When each cutoff size was evaluated by summary receiver operating characteristic (sROC) curves, the cutoff of 4 cm showed the highest summary area under the curve (sAUC, 0.645) compared to other cutoffs (sAUC, 0.58 with 2 cm, and 0.62 with 3 cm), although there was no significant difference.
CONCLUSIONS: Although the risk of malignancy increases with increasing tumor size, the risk remains significant at all tumor sizes and no cutoff limit can be recommended as a decision-making parameter for diagnostic surgery in Bethesda IV thyroid nodules.