Diagnostic performance of ultrasound elastography alone and in combination with conventional ultrasonography for Bethesda III-IV thyroid nodules: a systematic review and meta-analysis.

Abstract

<h4>Background</h4>The current diagnostic paradigm for thyroid nodule characterization predominantly depends on fine needle aspiration (FNA) cytology. Nevertheless, in cases of indeterminate cytology classified as Bethesda III and IV, the clinical community continues to face significant challenges in establishing reliable non-invasive diagnostic modalities for accurate pathological differentiation. This meta-analysis evaluates the diagnostic value of ultrasound elastography in Bethesda III-IV thyroid nodules, and compares the diagnostic efficacy when combined with conventional ultrasound.<h4>Methods</h4>We searched English medical databases, including PubMed, Embase, Web of Science, Cochrane Library, and Ovid, for relevant literature. These studies were reviewed by 2 members who also extracted pertinent data. We calculated pooled values via random effects meta-analysis to determine diagnostic performance.<h4>Results</h4>A total of 2,356 nodules were included in 27 studies. The overall sensitivity of ultrasound elastography was 0.81, the overall specificity was 0.83, the diagnostic odds ratio (DOR) was 16.40, and the area under the curve (AUC) was 0.87. A total of 8 articles incorporated the combined application of ultrasound elastography and conventional ultrasonography. The overall sensitivity was 0.87, the overall specificity was 0.73, the DOR was 21.33, and the AUC was 0.90.<h4>Conclusions</h4>Ultrasound elastography has good diagnostic value for Bethesda III-IV thyroid nodules, and the semiquantitative method outperforms the qualitative and quantitative methods. Ultrasound elastography in combination with conventional ultrasonography has better sensitivity and a lower specificity, and there is no significant difference between the 2 methods overall (P>0.05).