Diagnostic accuracy of thyroid nodule growth to predict malignancy in thyroid nodules with benign cytology: Systematic review and meta-analysis

Naykky Singh Ospina, Spyridoula Maraka, Ana Espinosa Deycaza, Derek O'Keeffe, Juan Brito Campana, Michael R. Gionfriddo, M. Regina Castro, John C. Morris, Patricia Erwin, Victor Manuel Montori

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Thyroid ultrasound to assess for nodular growth is commonly performed during the follow-up of patients with benign thyroid nodules, with the goal of identifying patients with a missed diagnosis of thyroid cancer. The objective of this study was to summarize the evidence regarding the diagnostic accuracy of growth during follow-up of benign thyroid nodules for thyroid cancer. Methods: We searched multiple electronic databases using a search strategy designed by an experienced medical librarian from inception to March 2015. Eligible studies included patients with benign thyroid nodules assessed for growth during follow-up and evaluated for thyroid cancer either by surgical histology or a repeat fine needle aspiration biopsy. Reviewers working independently and in duplicate recorded data and assessed each study. Results: The seven eligible studies lacked safeguards against bias and generated results that were imprecise with wide confidence intervals and inconsistent across studies. This warrants very low confidence in these results. The odds of nodule growth in patients with thyroid cancer on histopathology over these odds in patients without thyroid cancer (diagnostic odds ratio) was 0·58 (95% CI: 0·26-1·3); the diagnostic odds ratio was 2·2 (95% CI: 0·26-18) when an abnormal repeat biopsy was the reference standard. Conclusion: The body of evidence linking nodule growth with thyroid cancer during the follow-up of benign nodules warrants very low confidence. In the era of high-value health care, the commonplace practice of following benign thyroid nodules with serial ultrasound assessment of growth to diagnose cancer can be questioned, calling for imminent evaluation.

Original languageEnglish (US)
JournalClinical Endocrinology
DOIs
StateAccepted/In press - 2016

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Thyroid Nodule
Thyroid Neoplasms
Cell Biology
Meta-Analysis
Growth
Neoplasms
Odds Ratio
Librarians
Fine Needle Biopsy
Histology
Thyroid Gland
Databases
Confidence Intervals
Delivery of Health Care
Biopsy

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Diagnostic accuracy of thyroid nodule growth to predict malignancy in thyroid nodules with benign cytology : Systematic review and meta-analysis. / Singh Ospina, Naykky; Maraka, Spyridoula; Espinosa Deycaza, Ana; O'Keeffe, Derek; Brito Campana, Juan; Gionfriddo, Michael R.; Castro, M. Regina; Morris, John C.; Erwin, Patricia; Montori, Victor Manuel.

In: Clinical Endocrinology, 2016.

Research output: Contribution to journalArticle

Singh Ospina, Naykky ; Maraka, Spyridoula ; Espinosa Deycaza, Ana ; O'Keeffe, Derek ; Brito Campana, Juan ; Gionfriddo, Michael R. ; Castro, M. Regina ; Morris, John C. ; Erwin, Patricia ; Montori, Victor Manuel. / Diagnostic accuracy of thyroid nodule growth to predict malignancy in thyroid nodules with benign cytology : Systematic review and meta-analysis. In: Clinical Endocrinology. 2016.
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abstract = "Background: Thyroid ultrasound to assess for nodular growth is commonly performed during the follow-up of patients with benign thyroid nodules, with the goal of identifying patients with a missed diagnosis of thyroid cancer. The objective of this study was to summarize the evidence regarding the diagnostic accuracy of growth during follow-up of benign thyroid nodules for thyroid cancer. Methods: We searched multiple electronic databases using a search strategy designed by an experienced medical librarian from inception to March 2015. Eligible studies included patients with benign thyroid nodules assessed for growth during follow-up and evaluated for thyroid cancer either by surgical histology or a repeat fine needle aspiration biopsy. Reviewers working independently and in duplicate recorded data and assessed each study. Results: The seven eligible studies lacked safeguards against bias and generated results that were imprecise with wide confidence intervals and inconsistent across studies. This warrants very low confidence in these results. The odds of nodule growth in patients with thyroid cancer on histopathology over these odds in patients without thyroid cancer (diagnostic odds ratio) was 0·58 (95{\%} CI: 0·26-1·3); the diagnostic odds ratio was 2·2 (95{\%} CI: 0·26-18) when an abnormal repeat biopsy was the reference standard. Conclusion: The body of evidence linking nodule growth with thyroid cancer during the follow-up of benign nodules warrants very low confidence. In the era of high-value health care, the commonplace practice of following benign thyroid nodules with serial ultrasound assessment of growth to diagnose cancer can be questioned, calling for imminent evaluation.",
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AU - O'Keeffe, Derek

AU - Brito Campana, Juan

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N2 - Background: Thyroid ultrasound to assess for nodular growth is commonly performed during the follow-up of patients with benign thyroid nodules, with the goal of identifying patients with a missed diagnosis of thyroid cancer. The objective of this study was to summarize the evidence regarding the diagnostic accuracy of growth during follow-up of benign thyroid nodules for thyroid cancer. Methods: We searched multiple electronic databases using a search strategy designed by an experienced medical librarian from inception to March 2015. Eligible studies included patients with benign thyroid nodules assessed for growth during follow-up and evaluated for thyroid cancer either by surgical histology or a repeat fine needle aspiration biopsy. Reviewers working independently and in duplicate recorded data and assessed each study. Results: The seven eligible studies lacked safeguards against bias and generated results that were imprecise with wide confidence intervals and inconsistent across studies. This warrants very low confidence in these results. The odds of nodule growth in patients with thyroid cancer on histopathology over these odds in patients without thyroid cancer (diagnostic odds ratio) was 0·58 (95% CI: 0·26-1·3); the diagnostic odds ratio was 2·2 (95% CI: 0·26-18) when an abnormal repeat biopsy was the reference standard. Conclusion: The body of evidence linking nodule growth with thyroid cancer during the follow-up of benign nodules warrants very low confidence. In the era of high-value health care, the commonplace practice of following benign thyroid nodules with serial ultrasound assessment of growth to diagnose cancer can be questioned, calling for imminent evaluation.

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