Unnecessary thyroid nodule biopsy rates under four ultrasound risk stratification systems: a systematic review and meta-analysis

Abstract

Objectives: To summarize and compare unnecessary biopsy rates and diagnostic performance in the examination of thyroid nodules according to four representative US-based risk stratification systems. Methods: MEDLINE/PubMed and EMBASE databases were searched to identify original articles investigating unnecessary biopsy rates according to at least one of the following guidelines: ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS. The unnecessary biopsy rates for each risk stratification system were pooled using a random-effects model. Meta-regression analyses were performed to explore heterogeneity. Diagnostic odds ratios (DORs) for the appropriate selection of thyroid nodules for fine-needle aspiration were also pooled using a bivariate random-effects model. Results: Eight articles including 13,092 thyroid nodules met the eligibility criteria and were included. The pooled unnecessary biopsy rates of ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS were 25% (95% CI, 22?29%), 51% (95% CI, 44?58%), 38% (95% CI, 16?66%), and 55% (95% CI, 42?67%), respectively. The pooled unnecessary biopsy rate of ACR-TIRADS was significantly lower than that of ATA (p <.001) and K-TIRADS (p <.001), and also lower than that of EU-TIRADS, but not reaching statistical significance (p =.087). The pooled DORs of ACR-TIRADS, ATA, and K-TIRADS were 5.9 (95% CI, 3.6?9.6), 6.3 (95% CI, 4.5?8.8), and 4.5 (95% CI, 1.7?11.6), respectively, with the differences not being statistically significant. Conclusions: ACR-TIRADS showed a lower unnecessary biopsy rate than the other risk stratification systems albeit DOR was comparable between ACR-TIRADS, ATA, and K-TIRADS. Future revisions of each system should be made by referring to ACR-TIRADS to reduce unnecessary biopsy rates. Key Points: ? The pooled unnecessary biopsy rates of ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS were 25% (95% CI, 22?29%), 51% (95% CI, 44?58%), 38% (95% CI, 16?66%), and 55% (95% CI, 42?67%), respectively. ? The pooled unnecessary biopsy rate of ACR-TIRADS was significantly lower than that of ATA (p <.001) and K-TIRADS (p <.001). ? The pooled DORs of ACR-TIRADS, ATA, and K-TIRADS were 5.9 (95% CI, 3.6?9.6), 6.3 (95% CI, 4.5?8.8), and 4.5 (95% CI, 1.7?11.6), respectively, with the differences not being statistically significant.