PURPOSE Nearly half the cases of thyroid cancer, a malignancy rapidly rising in incidence within the United States, are attributable to small and asymptomatic papillary thyroid cancers that will not increase mortality. A primary driver of thyroid cancer overdiagnosis is ultrasound use. It is therefore valuable to understand how inappropriate use of thyroid ultrasound is defined, analyze the current evidence for its frequency, and identify interventions to lessen misuse. METHODS Ovid MEDLINE(R), Ovid EMBASE, and Scopus databases were searched from inception to June 2020 for studies assessing inappropriate use of thyroid ultrasound. Reviewers, working independently and in duplicate, evaluated studies for inclusion, extracted data, and graded risk of bias. We used a random-effects model with a generalized linear mixed approach to calculate the mean overall proportion estimates of inappropriate use. RESULTS Seven studies (total n = 1573) met the inclusion criteria with moderate to high risk of bias. Inappropriate thyroid ultrasound use was described variably, using published practice guidelines, third-party expert reviewers, or author interpretations of the literature. The overall frequency of inappropriate thyroid ultrasound use was 46% (95% CI 15-82%; n = 388) and 34% (95% CI 16-57%; n = 190) among studies using guideline based definitions. The pooled frequency of iUS due to thyroid dysfunction (either hypothyroidism or thyrotoxicosis) was 17% (95% CI 7-37%; n = 191) and the frequency of iUS due to nonspecific symptoms without a palpable mass was 11% (95% CI 5-22%; n = 124). No study examined interventions to address inappropriate use. CONCLUSIONS Low quality evidence suggests that inappropriate use of thyroid ultrasound is common. Interventional studies aiming to decrease the inappropriate use of thyroid ultrasound are urgently needed.

中文翻译：

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甲状腺超声的不当使用：系统评价和荟萃分析。

目的 甲状腺癌是一种在美国发病率迅速上升的恶性肿瘤，近一半病例是小型且无症状的甲状腺乳头状癌，不会增加死亡率。甲状腺癌过度诊断的一个主要驱动因素是超声的使用。因此，了解如何定义甲状腺超声的不当使用、分析其频率的当前证据并确定减少滥用的干预措施是有价值的。方法 检索了 Ovid MEDLINE(R)、Ovid EMBASE 和 Scopus 数据库，从成立到 2020 年 6 月，寻找评估甲状腺超声不当使用的研究。审稿人独立且重复地工作，评估研究的纳入情况、提取数据并对偏倚风险进行分级。我们使用随机效应模型和广义线性混合方法来计算不当使用的平均总体比例估计。结果 七项研究（总计 n = 1573）符合纳入标准，具有中度至高偏倚风险。使用已发表的实践指南、第三方专家评审员或作者对文献的解释对甲状腺超声的不当使用进行了不同的描述。在使用基于指南的定义的研究中，甲状腺超声使用不当的总体频率分别为 46%（95% CI 15-82%；n = 388）和 34%（95% CI 16-57%；n = 190）。因甲状腺功能障碍（甲状腺功能减退或甲状腺毒症）而导致的 iUS 合并频率为 17%（95% CI 7-37%；n = 191），因无明显肿块的非特异性症状而导致的 iUS 频率为 11%（95% CI） CI 5-22%；n = 124)。没有研究检查解决不当使用问题的干预措施。结论 低质量证据表明甲状腺超声的不当使用很常见。迫切需要旨在减少甲状腺超声的不当使用的干预性研究。