Systematic Review and Meta-Analysis of the Diagnostic Accuracy of the Sydney System for Reporting Lymph Node Fine-Needle Aspiration Biopsy in Diagnosing Malignancy.

IF 1.6 4区医学 Q3 PATHOLOGY Acta Cytologica Pub Date : 2024-01-01 Epub Date: 2023-12-14 DOI:10.1159/000535797

Sana Ahuja, Adil Aziz Khan, Rhea Ahuja, Pragun Ahuja, Sufian Zaheer

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Abstract

Introduction: The aim of the study was to perform the first meta-analysis for assessment of the pooled risk of malignancy of each category of the Sydney system for reporting of lymph nodal aspirates along with the evaluation of diagnostic accuracy.

Methods: PubMed/MEDLINE and Embase were searched with the following keywords: "(Lymph node) AND (fine needle aspiration biopsy) OR (International system OR Sydney system)" in the timeframe 2020 to August 4, 2023. The selected articles were assessed for the risk of bias by the QUADAS-2 tool. The meta-analysis for sensitivity (SN) and specificity for each cut-off, that is, "atypical considered positive," "suspicious of malignancy considered positive," and "malignant considered positive" for the lesions, was carried out after excluding the inadequate samples in each study. To assess the diagnostic accuracy, summary receiver operating characteristic curves were constructed, and the diagnostic odds ratio was pooled in both scenarios.

Results: Nine studies, all of which were retrospective cross-sectional studies, were evaluated with a total of 13,205 cases. The SN and specificity for the "atypical and higher risk categories" considered positive for malignancy were 97% (95% CI, 95-99%) and 96% (95% CI, 91-98%), respectively. The SN and specificity for the "suspicious of malignancy and higher risk categories" considered positive for malignancy were 91% (95% CI, 85-95%) and 99% (95% CI, 97-100%), respectively. The SN and specificity for the "malignant" considered positive for malignancy were 75% (95% CI, 65-84%) and 100% (95% CI, 99-100%), respectively. The pooled area under the curve was 99-100% for each of the cut-offs.

Conclusion: This meta-analysis highlights the accuracy of the Sydney system in reporting lymph node aspirates. It exhibits the significance of the "suspicious" and "malignant" categories in diagnosing malignancy and of the "benign" category in excluding malignancy.

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悉尼淋巴结细针抽吸活检诊断恶性肿瘤报告系统诊断准确性的系统回顾和荟萃分析》。

引言首次进行荟萃分析，评估悉尼淋巴结穿刺报告系统中各类别的恶性肿瘤风险以及诊断准确性。方法在 2020 年至 2023 年 8 月 4 日期间，以"（淋巴结）和（"细针穿刺活检 "或 FNAB）或（国际系统或悉尼系统）"为关键词对 Pubmed/ MEDLINE 和 Embase 进行检索。采用 QUADAS-2 工具对所选文章进行了偏倚风险评估。在排除每项研究中样本不足的情况后，对每种截断点（即 "非典型视为阳性"、"恶性可疑视为阳性 "和 "恶性视为阳性"）病变的敏感性和特异性进行了荟萃分析。为评估诊断准确性，构建了总结接收者操作特征曲线（sROC），并对两种情况下的诊断几率（DOR）进行了汇总。结果共评估了九项研究，均为回顾性横断面研究，共计 13205 个病例。被视为恶性肿瘤阳性的 "非典型和高风险类别 "的敏感性和特异性分别为 97%（95% CI，95%-99%）和 96%（95% CI，91%-98%）。被视为恶性肿瘤阳性的 "可疑恶性肿瘤和高风险类别 "的敏感性和特异性分别为 91%（95% CI，85%-95%）和 99%（95% CI，97%-100%）。恶性肿瘤阳性 "的敏感性和特异性分别为 75%（95% CI，65%-84%）和 100%（95% CI，99%-100%）。每个临界值的集合曲线下面积均为 99%-100%。结论该荟萃分析强调了悉尼系统在报告淋巴结穿刺方面的准确性。它显示了 "可疑 "和 "恶性 "类别在诊断恶性肿瘤方面的重要性，以及 "良性 "类别在排除恶性肿瘤方面的重要性。

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来源期刊

Acta Cytologica 生物-病理学

CiteScore

3.70

自引率

11.10%

发文量

审稿时长

4-8 weeks

期刊介绍： With articles offering an excellent balance between clinical cytology and cytopathology, ''Acta Cytologica'' fosters the understanding of the pathogenetic mechanisms behind cytomorphology and thus facilitates the translation of frontline research into clinical practice. As the official journal of the International Academy of Cytology and affiliated to over 50 national cytology societies around the world, ''Acta Cytologica'' evaluates new and existing diagnostic applications of scientific advances as well as their clinical correlations. Original papers, review articles, meta-analyses, novel insights from clinical practice, and letters to the editor cover topics from diagnostic cytopathology, gynecologic and non-gynecologic cytopathology to fine needle aspiration, molecular techniques and their diagnostic applications. As the perfect reference for practical use, ''Acta Cytologica'' addresses a multidisciplinary audience practicing clinical cytopathology, cell biology, oncology, interventional radiology, otorhinolaryngology, gastroenterology, urology, pulmonology and preventive medicine.