Malignancy Risk of Follicular Neoplasm (Bethesda IV) With Variable Cutoffs of Tumor Size: A Systemic Review and Meta-Analysis
Authors' conclusion
Although the risk of malignancy increases with increasing tumor size, the risk remains significant at all tumor sizes and no cutoff limit can be recommended as a decision-making parameter for diagnostic surgery in Bethesda IV thyroid nodules.
Study context
- Population
- Thyroid nodules diagnosed as follicular neoplasm/suspicious for follicular neoplasms (FN) (Bethesda IV) by fine needle aspiration, with postsurgical pathology
- Participants
- 2,016 participants14 observational studies
- Comparison
- Malignancy risk of FN/SFN nodules above vs below tumor size cutoffs
- Outcome
- Pooled malignancy risk of FN/SFN nodules according to tumor size cutoff
Methodological detailsleave-one-out meta-analysis, summary ROC analysis, Ovid-Medline, EMBASE, Cochrane and KoreaMed searched
- Leave-one-out meta-analysis
- Summary ROC analysis
- Ovid-Medline, EMBASE, Cochrane and KoreaMed searched
Pooled result
As reported in the abstract
Malignancy risk by tumor size cutoff
Odds ratio (95% CI)
≥4 cmvs <4 cm9 studies
2.29(1.68–3.11)
≥3 cmvs <3 cm3 studies
2.39(1.45–3.95)
≥2 cmvs <2 cm5 studies
1.81(0.94–3.50)
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| Malignancy risk with 2 cm cutoff, leave-one-out meta-analysis after removal of 1 influence study≥2 cmvs <2 cm | 2.43 (1.54–3.82) | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | ≥4 cm | ≥3 cm | ≥2 cm |
|---|---|---|---|
| Diagnostic performance of size cutoffs (sROC) | |||
| sAUC | 0.645 | 0.62 | 0.58 |
Diagnostic performance of size cutoffs (summary receiver operating characteristic (sROC))
- 4 cm cutoff had highest summary area under the curve (sAUC), but no significant difference between cutoffs
Original publication
Malignancy Risk of Follicular Neoplasm (Bethesda IV) With Variable Cutoffs of Tumor Size: A Systemic Review and Meta-Analysis. J Clin Endocrinol Metab. Published 19 December 2023. doi:10.
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