Tesis

Akurasi Diagnostik Keganasan Nodul Tiroid dengan Biopsi Aspirasi Jarum Halus dipandu Palpasi dan USG: Telaah Sistematis dan Metaanalisis = Diagnostic accuracy of ultrasound-guided vs palpation-guided fineneedle aspiration biopsy in detecting malignant thyroid nodule: A Systematic Review and Meta-analysis.

Latar Belakang: Nodul tiroid merupakan masalah kesehatan bidang endokrinologi yang banyak dijumpai pada praktik sehari-hari. Pemeriksaan sitologi fine needle aspiration biopsy (FNAB) atau Biopsi Aspirasi Jarum Halus (BAJAH) tiroid yang dikerjakan dengan panduan palpasi (palpation guided FNAB, PGFNAB) dan panduan ultrasonografi (USG guided FNAB, USGFNAB) merupakan pemeriksaan yang diandalkan untuk diagnosis kanker tiroid dan merupakan bagian integrasi penilaian nodul tiroid saat ini. Meskipun penelitian menunjukkan USGFNAB lebih akurat dibandingkan PGFNAB, masih terdapat inkonsistensi dari beberapa studi dan panduan klinis. Tujuan: Mengetahui perbandingan akurasi diagnostik USGFNAB vs PGFNAB. Metode: Telaah sistematis dan meta-analisis ini disusun berdasarkan standar PRISMA. Penelusuran literatur dilakukan pada tiga database online, yakni Pubmed/MEDLINE, Embase, dan Proquest, serta sumber literatur lainnya. Dilakukan ekstraksi data secara manual dari berbagai studi yang memenuhi eligibilitas, dilanjutkan analisis untuk memperoleh data gabungan sensitivitas, spesifisitas, diagnostik odds ratio dan AUC, serta perbandingan kedua metode tersebut. Hasil: Diperoleh 2517 artikel, dengan 11 studi dimasukkan ke telaah sistematis ini. Total sampel sebanyak 2382, mencakup 1128 subjek menggunakan PGFNAB dan 1254 subjek menggunakan USGFNAB. Risiko bias dinilai menggunakan QUADAS-2 dengan hasil ringan-sedang. Hasil sensitivitas, spesifisitas, AUC dan DOR dalam mendiagnosis keganasan nodul tiroid menggunakan PGFNAB adalah 76% (95% CI, 49-89%), 77% (95% CI, 56-95%, 0.827 dan 11.6 (95% CI, 6-21) secara berurutan. Hasil sensitivitas, spesifisitas, AUC dan DOR dalam mendiagnosis keganasan nodul tiroid menggunakan USGFNAB adalah 90% (95% CI, 81-95%), 80% (95% CI, 66-89%), 0.92 dan 40 (95% CI, 23-69) secara berurutan. Hasil uji perbandingan antara PGFNAB dan USGFNAB; Tsens USGFNAB sebesar 0.99 (p=0,023), uji perbedaan AUC 0.093 (p= 0.000023) Kesimpulan: Akurasi diagnostik USGFNAB lebih tinggi dibanding PGFNAB dalam mendiagnosis keganasan nodul tiroid. Penulis merekomendasikan penggunaan USGFNAB nodul tiroid pada rumah sakit yang mempunyai fasilitas USG.
Kata kunci: biopsi aspirasi jarum halus, kanker tiroid, nodul tiroid, palpasi, ultrasonografi


Background: Thyroid nodules are a common health problem in endocrinology. Thyroid fine needle aspiration biopsy (FNAB) cytology performed with palpation guided FNAB (PGFNAB) and ultrasound guided FNAB (USGFNAB) is the mainstay examination for the diagnosis thyroid cancer and part of integration the current thyroid nodule assessment. Although studies have shown USGFNAB to be more accurate than PGFNAB, there are still inconsistencies from several studies and clinical guidelines. Objective: Our study aims to compare the diagnostic accuracy of USGFNAB vs PGFNAB. Methods: This systematic review and meta-analysis was prepared based on the PRISMA standards. Literature searches were carried out on three online databases, namely Pubmed/MEDLINE, Embase, and Proquest, as well as other literature sources. Data extraction was carried out manually from various studies that met the eligibility, followed by analysis to obtain combined data on sensitivity, specificity, diagnostic odds ratio and AUC, and a comparison of the two methods. Result: 2517 articles were obtained, with 11 studies included in this systematic review. The total sample was 2382, including 1128 subjects using PGFNAB and 1254 subjects using USGFNAB. Risk of bias was assessed using QUADAS-2 with mild-moderate results. The results of sensitivity, specificity, AUC and DOR in diagnosing thyroid nodules using PGFNAB were 76% (95% CI, 49-89%), 77% (95% CI, 56-95%, 0.827 dan 11.6 (95% CI, 6-21) respectively. The results of sensitivity, specificity, AUC and DOR in diagnosing thyroid nodules using USGFNAB were 90% (95% CI, 81-95%), 80% (95% CI, 66-89%), 0.92 dan 40 (95% CI, 23-69), respectively the results of the comparison test between PGFNAB and USGFNAB; Tsens USGFNAB of 0.99 (p = 0.023), AUC difference test of 0.093 (p = 0.000023) Conclusion: The diagnostic accuracy of USGFNAB is higher than PGFNAB in diagnosing malignancy of thyroid nodules. If it’s accessible, the author recommends using USGFNAB as a diagnostic tool for thyroid nodules.
Keywords: fine needle aspiration biopsy, palpation, thyroid cancer, thyroid nodule, ultrasound