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Ultrasound is helpful to differentiate Bethesda class III thyroid nodules: A PRISMA-compliant systematic review and meta-analysis.

Abstract Fine-needle aspiration (FNA) is the most dependable tool to triage thyroid nodules for medical or surgical management. However, Bethesda class III cytology, namely "follicular lesion of undetermined significance" (FLUS) or "atypia of undetermined significance" (AUS), is a major limitation of the US-FNA in assessing thyroid nodules. As the most important imaging method, ultrasound (US) has a high efficacy in diagnosing thyroid nodules. This meta-analysis aimed to assess the role of US in evaluating Bethesda class III thyroid nodules.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28422844
OWN - NLM
STAT- In-Process
DA  - 20170419
LR  - 20170419
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 16
DP  - 2017 Apr
TI  - Ultrasound is helpful to differentiate Bethesda class III thyroid nodules: A
      PRISMA-compliant systematic review and meta-analysis.
PG  - e6564
LID - 10.1097/MD.0000000000006564 [doi]
AB  - BACKGROUND: Fine-needle aspiration (FNA) is the most dependable tool to triage
      thyroid nodules for medical or surgical management. However, Bethesda class III
      cytology, namely "follicular lesion of undetermined significance" (FLUS) or
      "atypia of undetermined significance" (AUS), is a major limitation of the US-FNA 
      in assessing thyroid nodules. As the most important imaging method, ultrasound
      (US) has a high efficacy in diagnosing thyroid nodules. This meta-analysis aimed 
      to assess the role of US in evaluating Bethesda class III thyroid nodules.
      METHODS: With keywords "Undetermined Significance," "Bethesda Category III,"
      "Bethesda system," "Cytological Subcategory," "AUS/FLUS," "Atypia of Undetermined
      Significance," and "Ultrasound/US," papers in PubMed, Cochrane Library, Medline, 
      Web of Science, Embase, and Google Scholar from inception to December 2016 were
      searched. A meta-analysis of these trials was then performed for evaluating the
      diagnostic value of thyroid ultrasound in Bethesda Category III thyroid nodules. 
      RESULTS: Fourteen studies including 2405 nodules were analyzed. According to the 
      criteria for US diagnosis of thyroid nodules in each article, with any one of
      suspicious features as indictors of malignancy, US had a pooled sensitivity of
      0.75 (95% CI 0.72-0.78) and a pooled specificity of 0.48 (95% CI 0.45-0.50) in
      evaluating Bethesda Class III Nodules. The pooled diagnostic odds ratio was 10.92
      (95% CI 6.04-19.74). The overall area under the curve was 0.84 and the Q* index
      was 0.77. With any 2 or 3 of US suspicious features as indictors of malignancy,
      the sensitivity and specificity were 0.77 (95% CI 0.71-0.83) and 0.54 (95% CI
      0.51-0.58), 0.66 (95% CI 0.59-0.73) and 0.71 (95% CI 0.68-0.74), respectively.
      CONCLUSIONS: US was helpful for differentiating benign and malignant Bethesda
      class III thyroid nodules, with the more suspicious features, the more likely to 
      be malignant.
FAU - Gao, Lu-Ying
AU  - Gao LY
AD  - Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union
      Medical College Hospital, Beijing, China.
FAU - Wang, Ying
AU  - Wang Y
FAU - Jiang, Yu-Xin
AU  - Jiang YX
FAU - Yang, Xiao
AU  - Yang X
FAU - Liu, Ru-Yu
AU  - Liu RY
FAU - Xi, Xue-Hua
AU  - Xi XH
FAU - Zhu, Shen-Ling
AU  - Zhu SL
FAU - Zhao, Rui-Na
AU  - Zhao RN
FAU - Lai, Xing-Jian
AU  - Lai XJ
FAU - Zhang, Xiao-Yan
AU  - Zhang XY
FAU - Zhang, Bo
AU  - Zhang B
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/04/20 06:00
MHDA- 2017/04/20 06:00
CRDT- 2017/04/20 06:00
AID - 10.1097/MD.0000000000006564 [doi]
AID - 00005792-201704210-00025 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Apr;96(16):e6564. doi: 10.1097/MD.0000000000006564.

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