title: Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for thyroid malignancy: systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically appraise and summarize the available evidence about the diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy (USFNA) for thyroid malignancy, and to explore the integration of these estimates with the probability of thyroid malignancy before USFNA.
  
  
  METHODS
  A comprehensive search of multiple databases from each database's inception to August 2014 was performed. Eligible studies included those that evaluated patients with thyroid nodules who underwent USFNA and subsequent evaluation by histopathology or long-term follow-up.
  
  
  RESULTS
  We identified 32 studies at moderate risk of bias evaluating the USFNA diagnostic characteristics for the diagnosis of thyroid malignancy. Results were imprecise and inconsistent across trials. The pooled likelihood ratio (LR) of thyroid malignancy for a benign USFNA result was 0.09 (95 % CI 0.06, 0.14; I (2) = 33 %), whereas the pooled LR for a malignant result was 197 (95 % CI, 68, 569; I (2) = 77 %). In the case of a suspicious for follicular neoplasm result, the pooled LR for malignancy was 0.6 (95 % CI, 0.4, 1.0; I (2) = 84 %) and 8.3 (95 % CI, 3.6, 19.2; I (2) = 89) for a result of suspicious for malignancy.
  
  
  CONCLUSIONS
  The available evidence regarding the diagnostic accuracy of USFNA warrants only limited confidence due to risk of bias, imprecision, and inconsistency. However, some USFNA results (benign, malignant) are likely very helpful, by significantly changing the pre-test probability of thyroid cancer.
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.|Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Naykky
authors.initials: N
authors.lastname: Singh Ospina
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.|Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Brito
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.|Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Spyridoula
authors.initials: S
authors.lastname: Maraka
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ana E
authors.initials: AE
authors.lastname: Espinosa de Ycaza
authors.affiliation: Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Rene
authors.initials: R
authors.lastname: Rodriguez-Gutierrez
authors.affiliation: Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.|Mayo Graduate School, Mayo Clinic, Rochester, MN, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Gionfriddo
authors.affiliation: Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.|Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Castaneda-Guarderas
authors.affiliation: Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.|Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN, USA.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Khalid
authors.initials: K
authors.lastname: Benkhadra
authors.affiliation: Division of Pediatric Endocrinology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Alaa
authors.initials: A
authors.lastname: Al Nofal
authors.affiliation: Mayo Medical Library, Mayo Clinic, Rochester, MN, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Erwin
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Morris
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: M Regina
authors.initials: MR
authors.lastname: Castro
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA. montori.victor@mayo.edu.|Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. montori.victor@mayo.edu.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000000981:diagnostic imaging* / Q000473:pathology; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Diagnosis; Thyroid cancer; Thyroid nodule; Ultrasound-guided fine needle aspiration biopsy