【摘要】：研究背景:近年來(lái)甲狀腺乳頭狀癌的發(fā)生率在世界范圍內(nèi)有所增加,尤其以甲狀腺微小乳頭狀癌的增加為著,雖然甲狀腺微小乳頭狀癌進(jìn)展緩慢,甚至終身不出現(xiàn)臨床癥狀,但是有極小部分被證實(shí)有侵襲性行為,并且有早期發(fā)生淋巴結(jié)及遠(yuǎn)處轉(zhuǎn)移的報(bào)道,因此能夠早期發(fā)現(xiàn)并診斷甲狀腺乳頭狀癌具有十分重要的臨床意義。有許多研究討論了縱橫比與甲狀腺結(jié)節(jié)惡性風(fēng)險(xiǎn)的關(guān)系,并且有許多研究根據(jù)結(jié)節(jié)的大小分類,研究了縱橫比在不同大小的結(jié)節(jié)中的診斷價(jià)值,但是這些研究的結(jié)論存在爭(zhēng)議。目的:采用診斷性試驗(yàn)的meta分析的方法評(píng)估A/T1在不同大小的甲狀腺乳頭狀癌的診斷價(jià)值,以期為臨床工作中A/T1在診斷甲狀腺乳頭狀癌中提供更可靠的依據(jù)。方法:計(jì)算機(jī)全面在線檢索Pubmed和Embase兩個(gè)數(shù)據(jù)庫(kù),查閱1990年1月至2016年12月期間發(fā)表的相關(guān)中英文文獻(xiàn)。檢索結(jié)束后,由兩名評(píng)價(jià)員獨(dú)立對(duì)所得文獻(xiàn)嚴(yán)格執(zhí)行納入排除標(biāo)準(zhǔn)進(jìn)行篩選,使用Meta-Disc 1.4軟件完成納入文獻(xiàn)的Meta分析。結(jié)果:通過(guò)閱讀納入文獻(xiàn),最終得到了來(lái)自韓國(guó)和中國(guó)兩個(gè)國(guó)家共8篇文獻(xiàn),均為回顧性研究。這些文獻(xiàn)共包括病例數(shù)4778例,結(jié)節(jié)10mm的占24%(1150例),結(jié)節(jié)≤10mm的占78%(3628例)。Meta分析結(jié)果顯示:A/T1在結(jié)節(jié)10mm和結(jié)節(jié)≤10mm診斷中的合并敏感性分別為0.38、0.65;合并特異性分別為0.93、0.80;合并陽(yáng)性似然比分別為3.96、3.74;合并陰性似然比分別為0.75、0.38;合并診斷比值比分別為6.18、12.38,合并敏感度和特異度結(jié)果并計(jì)算SROC曲線下面積,A/T1在結(jié)節(jié)10mm診斷中的曲線下面積(AUC)為0.8165,在結(jié)節(jié)≤10mm診斷中的曲線下面積(AUC)為0.8394。結(jié)論:A/T1作為PTC的特征性超聲診斷征象,A/T1對(duì)于診斷PTC≤10mm的特異性、敏感性以及準(zhǔn)確度均比較高,對(duì)于PTC10mm其特異性和準(zhǔn)確度均比較高,但是敏感度低,因此A/T1是診斷最大徑≤10mm PTC可靠的超聲特征性表現(xiàn),可以作為主要的診斷標(biāo)準(zhǔn),而A/T1不適宜作為最大直徑10mm的PTC的主要診斷標(biāo)準(zhǔn)。
[Abstract]:Background: the incidence of thyroid papillary carcinoma has increased worldwide in recent years, especially the increase in thyroid micropapillary carcinoma, although the progression of thyroid micropapillary carcinoma is slow, even if it does not appear clinical symptoms for life. However, a very small number of thyroid papillary carcinomas have been confirmed to have aggressive behavior, and early occurrence of lymph nodes and distant metastasis has been reported, so it is of great clinical significance to detect and diagnose papillary thyroid carcinoma at an early stage. Many studies have discussed the relationship between aspect ratio and malignant risk of thyroid nodules, and many studies have studied the diagnostic value of aspect ratio in nodules of different sizes according to the size of nodules, but the conclusions of these studies are controversial. Objective: to evaluate the diagnostic value of A/T1 in different sizes of papillary thyroid carcinoma by meta analysis of diagnostic test, so as to provide a more reliable basis for the diagnosis of papillary thyroid carcinoma by A/T1 in clinical work. Methods: two databases, Pubmed and Embase, were searched online by computer and the relevant Chinese and English literatures published from January 1990 to December 2016 were consulted. At the end of the retrieval, two evaluators independently screened the inclusion exclusion criteria for strict implementation of the literature, and used Meta-Disc 1.4 software to complete the Meta analysis of the included documents. Results: 8 articles were collected from Korea and China, which were all retrospective studies. The literature includes 4778 cases. 24% (1150 cases) of nodular 10mm and 78% of nodular 鈮，

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