Diagnostic accuracy of utrasonographic features in detecting thyroid cancer in the transition age: a meta-analysis

in European Thyroid Journal
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  • 1 A Cozzolino, Department of Experimental Medicine, University of Rome La Sapienza, Rome, Italy
  • | 2 T Filardi, Department of Experimental Medicine, University of Rome La Sapienza, Rome, Italy
  • | 3 I Simonelli, PhD Student, Dipartimento di Biomedicina e Prevenzione, University of Rome Tor Vergata, Roma, Italy
  • | 4 G Grani, Department of Translational and Precision medicine, University of Rome La Sapienza, Rome, Italy
  • | 5 C Virili, Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, University of Rome La Sapienza, Rome, Italy
  • | 6 I Stramazzo, Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, University of Rome La Sapienza, Rome, Italy
  • | 7 M Santaguida, Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, University of Rome La Sapienza, Rome, Italy
  • | 8 P Locantore, Università Cattolica del Sacro Cuore, Unit of Endocrinology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
  • | 9 M Maurici, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Roma, Italy
  • | 10 D Gianfrilli, Department of Experimental Medicine, University of Rome La Sapienza, Rome, Italy
  • | 11 A Isidori, Department of Experimental Medicine, University of Rome La Sapienza, Rome, Italy
  • | 12 C Durante, Department of Translational and Precision Medicine, University of Rome La Sapienza, Rome, Italy
  • | 13 C Pozza, Department of Experimental Medicine, University of Rome La Sapienza, Rome, Italy

Correspondence: Carlotta Pozza, Email: carlotta.pozza@uniroma1.it
Open access

Context: Significant uncertainty exists about the diagnostic accuracy of ultrasonographic (US) features used to predict the risk of thyroid cancer in the pediatric population. Moreover, there are not specific indications for thyroid nodule evaluation in patients during the transition age.

Objective: The meta-analysis aimed to address the following question: which thyroid nodule US features have the highest accuracy in predicting malignancy in the transition age.

Methods: We performed a meta-analysis of observational/cohort/diagnostic accuracy studies dealing with thyroid nodule sonography, reporting US features, and using histology as reference standard for the diagnosis of malignancy and histology or cytology for the diagnosis of benignity in the transition age (mean/median age 12-21 years).

Results: The inclusion criteria were met by 14 studies, published between 2005 and 2020, including 1306 thyroid nodules (mean size 17.9 mm) from 1168 subjects. The frequency of thyroid cancer was 36.6%. The US features with the highest diagnostic odds ratio for malignancy were the presence of suspicious lymph nodes [DOR: 56.0 (95% CI: 26.0-119.0)], a “taller than wide” shape of the nodule [6.0 (95% CI: 2.0-16.0)], the presence of microcalcifications [13.0 (95% CI: 6.0-29.0)] and irregular margins [9.0 (95% CI: 5.0-17.0)]. Heterogeneity among the studies was substantial.

Conclusions: Following the diagnosis of a thyroid nodule in transition age, a thorough US examination of the neck is warranted. The detection of suspicious lymph nodes and/or thyroid nodules with a “taller than wide” shape, microcalcifications and irregular margins is associated with the highest risk of malignancy in the selection of nodules candidates to biopsy.