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Diagnostic performance of adult-based ATA and ACR-TIRADS ultrasound risk stratification systems in pediatric thyroid nodules: a systematic review and meta-analysis

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Abstract
Objectives: To evaluate the diagnostic performance of adult-based "American College of Radiology- Thyroid Imaging Reporting And Data System" (ACR-TIRADS) and "American Thyroid Association" (ATA) in the pediatric population.

Methods: MEDLINE/PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched for articles investigating the diagnostic performance of each stratification system (ACR-TIRADS or ATA) and evaluated them according to three aspects: (a) the risk of malignancy in each category; (b) diagnostic performance using the classic indicators (sensitivity, specificity); and (c) diagnostic performance regarding fine needle aspiration/biopsy recommendation. In addition to pathologic diagnosis, we allowed imaging follow-up as the reference standard for benign nodules.

Results: Eight articles (1036 thyroid nodules) were included. For ACR-TIRADS, the pooled risk of malignancy in category was as follows: category 5 (59.3%); 4 (20.7%); 3 (11.0%); 2 (6.0%), and 1 (5.5%). For nodules of high suspicion of malignancy (category 4 or 5), the pooled sensitivity and specificity were 0.84 and 0.64. For ATA, the pooled risk of malignancy was as follows: category 5 (55.4%); 4 (34.2%); 3 (12.2%); and 2 (7.5%). For nodules of high suspicion of malignancy (category 4 or 5), the pooled sensitivity and specificity were 0.90 and 0.50. For category 5 nodules, the pooled specificity was significantly higher in ACR-TIRADS (p = 0.02). For ACR-TIRADS, the missed malignancy rate was 21.7% and the unnecessary biopsy rate was 62.7%. Information was not sufficient for this calculation with ATA.

Conclusions: The diagnostic performance of ACR-TIRADS and ATA in the pediatric population was somewhat modest. Large studies are mandatory for further validation and future amendments.
Author(s)
김평화백정환윤희망이진성정아영조영아황지선
Issued Date
2021
Type
Article
Keyword
ChildMeta-analysisThyroidThyroid neoplasmsUltrasonography.
DOI
10.1007/s00330-021-07908-8
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7421
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2514607258&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Diagnostic%20performance%20of%20adult-based%20ATA%20and%20ACR-TIRADS%20ultrasound%20risk%20stratification%20systems%20in%20pediatric%20thyroid%20nodules:%20a%20systematic%20review%20and%20meta-analysis&offset=0&pcAvailability=true
Publisher
EUROPEAN RADIOLOGY
Location
미국
Language
영어
ISSN
0938-7994
Citation Volume
31
Citation Number
10
Citation Start Page
7450
Citation End Page
7463
Appears in Collections:
Medicine > Medicine
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