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目的:评价甲状腺结节的前后径与横径比值(A/T)≥1对其良恶性的诊断价值。方法:检索多个国内外数据库,收集2017年7月前发表的有关评价甲状腺结节A/T≥1对于恶性甲状腺结节诊断价值的诊断性研究。按照纳入标准筛选文献、提取资料和质量评价后,用Meta-Disc 1.4统计软件对数据进行分析。对纳入文献间的异质性进行评估,计算纳入研究中甲状腺结节A/T≥1诊断其为恶性的合并效应量,包括灵敏度、特异度、阳性似然比(PLR)、阴性似然比(NLR)、诊断比值比(DOR)、综合受试者工作特征曲线下面积(AUC)与Q*指数;采用敏感性分析评估研究结果的稳定性,并寻找研究间异质性来源。绘制Deek漏斗图评估研究结果所致的发表偏倚。结果:共纳入13篇研究,总计11 243枚结节,其中良性结节9 227枚,恶性结节2 016枚。13篇文献评估后质量高低不一,纳入研究间存在非阈值效应引起的异质性(r=0.352,P=0.239)。甲状腺结节A/T≥1诊断其为恶性的合并灵敏度为0.31(95%CI=0.29~0.33)、特异度为0.50(95%CI=0.49~0.51)、PLR为1.32(95%CI=0.81~2.14)、NLR为0.85(95%CI=0.73~0.99)、DOR为1.51(95%CI=0.77~2.90)、AUC为0.538 9、Q*值为0.529 2。纳入研究总体合并效应量结果稳定性好,异质性来源可能为研究方法,种族差异,是否采用盲法等,Deek漏斗图显示研究结果呈不对称分布,存在纳入研究结果所致的发表偏倚。结论:甲状腺结节A/T≥1对甲状腺结节的良恶性具有一定的诊断价值;但敏感度、特异度较低,需结合其他影像学征象综合判断。
Objective: To evaluate the value of anteroposterior diameter to transverse diameter (A / T) ≥1 in the diagnosis of benign and malignant thyroid nodules. Methods: We searched a number of domestic and foreign databases and collected diagnostic data about the diagnostic value of thyroid nodules A / T≥1 for malignant thyroid nodules published before July 2017. According to the inclusion criteria of screening the literature, data extraction and quality evaluation, Meta-Disc 1.4 statistical software for data analysis. The inclusion heterogeneity among the literature was assessed and the combined effect of the diagnosis of thyroid nodules A / T> 1 in the study to be malignant was calculated, including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the receiver operating characteristic curve (AUC) and Q * index. Sensitivity analysis was used to assess the stability of the study results and to find sources of heterogeneity among studies. Draw a Deek funnel plot to assess publication bias resulting from the study. Results: A total of 13 studies were included in the study, totaling 11,243 nodules, including 9,227 benign nodules and 2,161 malignant nodules. The quality of the 13 articles was variable, with heterogeneity of non-threshold effects (r = 0.352, P = 0.239) included in the study. Thyroid nodules had a combined sensitivity of 0.31 (95% CI = 0.29-0.33), specificity of 0.50 (95% CI = 0.49-0.51) and PLR of 1.32 (95% CI = 0.81 ~ 2.14), NLR was 0.85 (95% CI = 0.73-0.99), DOR was 1.51 (95% CI = 0.77-2.90), AUC was 0.5389 and Q * was 0.529 2. The overall merging effect of the included studies shows good stability of the results. The sources of heterogeneity may be research methods, ethnic differences, whether to adopt the blind method or not. The Deek funnel plot shows that the research results are asymmetric and the publication bias caused by the inclusion of the research results exists. Conclusions: The thyroid nodules A / T≥1 have some diagnostic value on the benign and malignant thyroid nodules. However, the sensitivity and specificity are low, so they need to be combined with other imaging findings.