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Review
. 2022 Oct 14;10(10):2575.
doi: 10.3390/biomedicines10102575.

Radiologist versus Non-Radiologist Detection of Lymph Node Metastasis in Papillary Thyroid Carcinoma by Ultrasound: A Meta-Analysis

Peter P Issa  1 , Lauren Mueller  2 , Mohammad Hussein  3 , Aaron Albuck  2 , Mohamed Shama  3 , Eman Toraih  3   4 , Emad Kandil  3
Affiliations
Review

Radiologist versus Non-Radiologist Detection of Lymph Node Metastasis in Papillary Thyroid Carcinoma by Ultrasound: A Meta-Analysis

Peter P Issa et al. Biomedicines. .

Abstract

Papillary thyroid carcinoma (PTC) is the most common thyroid cancer worldwide and is known to spread to adjacent neck lymphatics. Lymph node metastasis (LNM) is a known predictor of disease recurrence and is an indicator for aggressive resection. Our study aims to determine if ultrasound sonographers' degree of training influences overall LNM detection. PubMed, Embase, and Scopus articles were searched and screened for relevant articles. Two investigators independently screened and extracted the data. Diagnostic test parameters were determined for all studies, studies reported by radiologists, and studies reported by non-radiologists. The total sample size amounted to 5768 patients and 10,030 lymph nodes. Radiologists performed ultrasounds in 18 studies, while non-radiologists performed ultrasounds in seven studies, corresponding to 4442 and 1326 patients, respectively. The overall sensitivity of LNM detection by US was 59% (95%CI = 58-60%), and the overall specificity was 85% (95%CI = 84-86%). The sensitivity and specificity of US performed by radiologists were 58% and 86%, respectively. The sensitivity and specificity of US performed by non-radiologists were 62% and 78%, respectively. Summary receiver operating curve (sROC) found radiologists and non-radiologists to detect LNM on US with similar accuracy (p = 0.517). Our work suggests that both radiologists and non-radiologists alike detect overall LNM with high accuracy on US.

Keywords: lymph node metastasis; radiologist; thyroid cancer; ultrasound.

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Conflict of interest statement

All authors declare no conflict of interest. The sponsors had no role in the design, execution, interpretation, or writing of the study.

Figures

Figure 1
Figure 1
Workflow of the literature search. A total of 25 studies were included.
Figure 2
Figure 2
Diagnostic parameters of ultrasound performed by radiologists [18,20,22,23,24,25,26,27,28,29,30,32,34,35,36,37,38,39]. The (A) sensitivity, (B) specificity, (C) positive likelihood ratio, and (D) negative likelihood ratio are presented. Data is reported as an estimate and 95% confidence interval. Heterogeneity was assessed using Cochran-Q test and magnitude was estimated by the I-square value. CI = Confidence Interval; LR = Likelihood Ratio.
Figure 3
Figure 3
Diagnostic parameters of ultrasound performed by non-radiologists [13,19,21,22,31,33,41]. The (A) sensitivity, (B) specificity, (C) positive likelihood ratio, and (D) negative likelihood ratio are presented. Data is reported as an estimate and 95% confidence interval. Heterogeneity was assessed using Cochran-Q test and magnitude was estimated by the I-square value. CI = Confidence Interval; LR = Likelihood Ratio.
Figure 4
Figure 4
Comparison of diagnostic parameters of ultrasound performed by radiologists with those performed by non-radiologists. The (A) diagnostic odds ratio of radiologists [18,20,23,24,25,26,27,28,29,30,32,34,35,36,37,38,39], (B) diagnostic odds ratio of non-radiologists [13,19,21,22,31,33,41], and (C) summary receiver operating curve are presented. Summary receiver operating curve is presented as an area under the curve and standard error. Heterogeneity was assessed using Cochran-Q test and magnitude was estimated by the I-square value. OR = Odds Ratio; CI = Confidence Interval; AUC = area under the curve; sROC = summary receiver operating curve.
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