Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences · 2026
[Fine-needle aspiration cytology and fine-needle aspirate calci-tonin measurement for diagnosing medullary thyroid carci-noma: a meta-analysis].
СтатьяМетаанализСистематический обзорАннотация на английскомНазвание и аннотация: Перевод пока не подготовлен
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Zhang Jianhua, Yu Junkang, Huang Chenhao, Zhang Minghuang, Zhang Kanghui, Meng Ning
Аннотация
OBJECTIVES: To systematically evaluate the diagnostic value of fine-needle aspiration cytology (FNAC) and fine-needle aspirate calcitonin (FNA-CT) measurement in medullary thyroid carcinoma (MTC). This study has been registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD420251243288) and was conducted and reported in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) 2018.
METHODS: Relevant studies evaluating FNAC and FNA-CT for the diagnosis of MTC were systematically searched in Chinese and English databases from January 1, 1995 to December 31, 2024. The methodological quality of the included studies was assessed using the QUADAS-2, and meta-analysis was performed using Stata 16.0. The threshold effect was evaluated using the Spearman correlation test, and heterogeneity was assessed using Cochran's Q test and the I² statistic. A fixed-effects or random-effects model was selected according to the degree of heterogeneity. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated, and summary receiver operating characteristic (SROC) curves and forest plots were generated to evaluate diagnostic performance. Meta-regression analysis was further conducted to explore potential sources of heterogeneity. Deeks' funnel plot was used to assess publication bias, while Fagan nomogram and the likelihood ratio scattergram were used to evaluate clinical utility.
RESULTS: A total of 13 studies involving 937 patients with 444 MTC lesions were finally included. The Spearman correlation test showed no obvious threshold effect for FNAC in diagnosing MTC, whereas a potential threshold effect was observed for FNA-CT. Heterogeneity analysis revealed varying degrees of heterogeneity across the diagnostic performance indicators of both FNAC and FNA-CT; therefore, random-effects models were used for pooled analysis. For FNAC, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.56 (95%CI: 0.51-0.61), 0.98 (95%CI: 0.94-1.00), 34.25 (95%CI: 8.98-130.62), 0.45 (95%CI: 0.39-0.51), and 76.97 (95%CI: 18.72-316.52), respectively. For FNA-CT, the corresponding values were 0.98 (95%CI: 0.94-0.99), 0.97 (95%CI: 0.94-0.99), 37.42 (95%CI: 16.91-82.80), 0.02 (95%CI: 0.01-0.06), and 1891.55 (95%CI: 351.09-10 191.13), respectively. The SROC AUCs of FNAC and FNA-CT for diagnosing MTC were 0.65 and 1.00, respectively. Meta-regression analysis suggested that the heterogeneity of FNAC might be related to study design and detection method, whereas no significant source of heterogeneity was identified for FNA-CT. Possible publication bias was detected for both methods. Both Fagan nomogram analysis and likelihood ratio scattergram analysis showed that FNA-CT had high clinical value for both confirming and excluding MTC, whereas FNAC had good value for confirming MTC but limited value for excluding it.
CONCLUSIONS: FNA-CT demonstrates high diagnostic value for MTC, with overall diagnostic efficacy superior to that of FNAC.
METHODS: Relevant studies evaluating FNAC and FNA-CT for the diagnosis of MTC were systematically searched in Chinese and English databases from January 1, 1995 to December 31, 2024. The methodological quality of the included studies was assessed using the QUADAS-2, and meta-analysis was performed using Stata 16.0. The threshold effect was evaluated using the Spearman correlation test, and heterogeneity was assessed using Cochran's Q test and the I² statistic. A fixed-effects or random-effects model was selected according to the degree of heterogeneity. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated, and summary receiver operating characteristic (SROC) curves and forest plots were generated to evaluate diagnostic performance. Meta-regression analysis was further conducted to explore potential sources of heterogeneity. Deeks' funnel plot was used to assess publication bias, while Fagan nomogram and the likelihood ratio scattergram were used to evaluate clinical utility.
RESULTS: A total of 13 studies involving 937 patients with 444 MTC lesions were finally included. The Spearman correlation test showed no obvious threshold effect for FNAC in diagnosing MTC, whereas a potential threshold effect was observed for FNA-CT. Heterogeneity analysis revealed varying degrees of heterogeneity across the diagnostic performance indicators of both FNAC and FNA-CT; therefore, random-effects models were used for pooled analysis. For FNAC, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.56 (95%CI: 0.51-0.61), 0.98 (95%CI: 0.94-1.00), 34.25 (95%CI: 8.98-130.62), 0.45 (95%CI: 0.39-0.51), and 76.97 (95%CI: 18.72-316.52), respectively. For FNA-CT, the corresponding values were 0.98 (95%CI: 0.94-0.99), 0.97 (95%CI: 0.94-0.99), 37.42 (95%CI: 16.91-82.80), 0.02 (95%CI: 0.01-0.06), and 1891.55 (95%CI: 351.09-10 191.13), respectively. The SROC AUCs of FNAC and FNA-CT for diagnosing MTC were 0.65 and 1.00, respectively. Meta-regression analysis suggested that the heterogeneity of FNAC might be related to study design and detection method, whereas no significant source of heterogeneity was identified for FNA-CT. Possible publication bias was detected for both methods. Both Fagan nomogram analysis and likelihood ratio scattergram analysis showed that FNA-CT had high clinical value for both confirming and excluding MTC, whereas FNAC had good value for confirming MTC but limited value for excluding it.
CONCLUSIONS: FNA-CT demonstrates high diagnostic value for MTC, with overall diagnostic efficacy superior to that of FNAC.