Suboptimal accuracy of ultrasound and ultrasound‐based risk stratification systems in detecting medullary thyroid carcinoma should not be overlooked. Findings from a systematic review with meta‐analysis

Abstract

Objective Ultrasound (US) is the pivotal procedure during the diagnostic work‐up of thyroid nodule and several US‐based risk stratification systems (RSSs) have been recently developed. Since the performance of RSSs in detecting medullary thyroid carcinoma (MTC) has been rarely investigated, the present systematic review aimed to achieve high evidence about (1) how MTC is classified according to RSSs; (2) if RSSs correctly classify MTC at high risk/suspicion, and (3) if MTC is classified as suspicious at US when RSSs are not used. Design The review was performed according to MOOSE. The online search was performed by specific algorithm on January 2022. A random‐effects model was used for statistical analysis. Results Twenty‐five papers were initially included and their risk of bias was generally low. According to ATA system, 65% of MTCs was assessed at high suspicion and 25% at intermediate suspicion. Considering all RSSs, a 54.8% of MTCs was put in a high‐risk/suspicion category. Pooling data from studies without data of RSS the prevalence of ultrasonographically suspicious MTCs was 60%. Conclusions As conclusion, MTC presentation according to RSSs is partially known and it is classified in a high‐risk/suspicion category of RSSs in just over a half of cases. This advises for further studies, ideally supported by international societies, to better define the US presentation of MTC.

Diagnostic tests for medullary thyroid carcinoma: an umbrella review

“…Three systematic reviews [18][19][20] aimed at evaluating the US presentation of MTC. The first one [18] reported the performance of US in detecting MTC.…”

“…[ [18][19][20] MTC is classified at high risk/suspicion according to RSSs/TIRADSs in just over half of cases.…”

Efficacy analysis between ultrasound and cytology criteria in the differentiation of malignant and benign thyroid nodules: TIRADS versus BETHESDA

“…USG has a very flexible diagnostic power and can distinguish between solid and cystic within the framework of the user's competence (6). In addition, it supports the distinction between benign and malignant nodules based on features such as the more solid structure of the nodule, its echogenicity, border irregularity, and the presence of microcalcifications (7,8).…”

Evaluation of the Performance of ACR TI-RADS Also Considering Those Nodules with No Indication of FNAC: A Single-Center Experience

“…Several biases can affect the results of this specific literature. First, most studies used only cytology as a reference standard, often excluding less frequent cancers (i.e., follicular and medullary) [ 15 , 16 ]. Second, the largest part of these studies included only series of nodules that underwent FNAC; poor or no information was described for those lesions without indications to FNAC according to RSS.…”