Diagnostic value of cytology, thyroglobulin, and combination of them in fine-needle aspiration of metastatic lymph nodes in patients with differentiated thyroid cancer: A systematic review and network meta-analysis

BACKGROUND: To investigate the diagnostic performance of cytology (fine-needle aspiration cytology [FNAC]), thyroglobulin (fine-needle aspiration thyroglobulin [FNA-Tg]), and combination of them in the washout of fine-needle aspiration for those patients who have suspicious metastatic lymph nodes of differentiated thyroid cancer. METHODS: Databases, including PubMed, EMbase, Web of Science and Cochrane Library were searched up to June 2019. The quality assessment of diagnostic accuracy scale-2 was used to conduct quality assessments, and publication bias was evaluated using the Deeks funnel plot. STATA version 14.0 was used to perform the meta-analysis. RESULTS: A total of 2257 patients with 2786 samples of suspicious metastatic lymph nodes of differentiated thyroid cancer were included in the meta-analysis. The results showed that the diagnostic value for detecting lymph node metastasis of differentiated thyroid cancer was as follows: combination of FNAC and FNA-Tg > FNA-Tg > FNAC. All differences of superiority among them are statistically significant. The sensitivity of the combination was 0.968 (95% confidence interval [CI]: 0.942–0.983), the specificity was 0.932 (95% CI: 0.856–0.969), the diagnostic score was 6.036 (95% CI: 4.892–7.181), the diagnostic odds ratio was 418.424 (95% CI: 133.167–1314.729), and the score of summary receiver operating characteristic was 0.99 (95% CI: 0.97–0.99). CONCLUSIONS: The combination of FNAC and FNA-Tg is an excellent procedure in diagnosis of lymph nodes metastasis of patients with differentiated thyroid cancer, which should be highly recommended.