摘要：
Objective To evaluate the value of ultrasound-guided core needle biopsy(US-CNB) in diagnosing malignant and benign thyroid nodule by meta-analysis.Methods A computer-based online retrieval on the accurate tests of US-CNB for diagnosing thyroid nodule was conducted in PubMed,Cochrane Library (Issue 5,2016),EMbase,CBM,CNKI,VIP,Wangfang Data databases.The retrieval time limit was from the database establishment to June 8,2016.The quality of included articles was assessed by using the quality assessment of diagnostic accuracy studies (QUADAS).The puncture success rate,diagnosis sensitivity (Sen),specificity (Spe),positive likelihood ratio (+LR),negative likelihood ratio (-LR),diagnostic odds ratio (DOR) and area under the curve (AUC) of summary receiver operating characteristic curve (SROC) were served as the outcome indicators.The included data were performed the statistical analysis by using STATA12.0 and Meta-Disc 1.4 softwares.Results A total of 29 diagnostic accuracy trials were finally included,involving 4 213 patients with 4 391 thyroid nodules.The meta-analysis results suggested that the US-CNB puncture success rate was 98.7 ％ [95％ CI (98.3 ％,99.0 ％)];Sen of US-CNB for diagnosing thyroid nodule was 0.94 [95％CI(0.93,0.95)],Spe=0.98[95 ％CI(0.98,0.99)],+LR=33.96[95％CI(20.31,56.78)],-LR=0.06[95％CI(0.04,0.10)],DOR=581.44[95 ％CI(335.08,1 007.87)],and the AUC of SROC was 0.99.Conclusion The current evidences indicate that UG-CNB has high diagnostic accuracy in benign and malignant thyroid nodules,and is worth promotion and application in clinic.%目的 通过Meta分析的方法评价超声引导下粗针穿刺活检(US-CNB)诊断甲状腺良恶性结节的价值.方法 计算机检索PubMed、The Cochrane Library(2016年第5期)、Embase、中国生物医学文献数据库、中国知网、维普、万方数据库中关于US-CNB诊断甲状腺结节的诊断准确性试验,检索时限为各数据库建库至2016年6月8日.采用诊断性试验准确性质量评价工具(QUADAS)评价纳入文献的质量,以穿刺成功率、诊断灵敏度(Sen)、特异度(Spe)、阳性似然比(+LR)、阴性似然比(-LR)、诊断优势比(DOR)及汇总受试者工作特征(SROC)曲线下面积(AUC)为结局指标,运用STATA12.0和Meta-DiSc1.4软件对纳入研究数据进行统计分析.结果 最终29篇诊断准确性试验,共4 213例甲状腺结节患者4 391个结节被纳入分析.Meta分析结果显示,US-CNB穿刺成功率为98.7％[95％CI(98.3％,99.0％)];US-CNB诊断甲状腺结节的Sen=0.94[95％CI(0.93,0.95)],Spe=0.98[95％CI(0.98,0.99)],+LR=33.96[95％CI(20.31,56.78)],-LR=0.06[95％CI(0.04,0.10)],DOR=581.14[95％CI(335.08,1007.87)],AUC为0.99.结论 当前的证据显示,US-CNB对甲状腺良、恶性结节的诊断准确性较高,值得临床推广运用.
