Diagnostic performance of HMGA2 gene expression for differentiation of malignant thyroid nodules: A systematic review and meta-analysis

Objective The purpose of the current study was to investigate the diagnostic performance of high mobility group A2 (HMGA2) gene expression for differentiation of malignant thyroid nodules through a systematic review and meta-analysis. Design The MEDLINE/PubMed and EMBASE database, from the earliest available date of indexing through 10 April 2018, were searched for studies evaluating the diagnostic performance of HMGA2 expression for differentiation of thyroid nodules. Methods We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic (ROC) curves. Results Across 7 studies, the pooled sensitivity for HMGA2 expression was 0.78 (95% CI; 0.67-0.86) with heterogeneity (I2 = 86.6) and a pooled specificity of 0.94 (95% CI: 0.85-0.98) with heterogeneity (I2 = 94.7). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 12.6 (95% CI: 5.1-31.3) and negative likelihood ratio (LR-) of 0.24 (95% CI: 0.15-0.36). The pooled diagnostic odds ratio (DOR) was 53 (95% CI: 18-159). Hierarchical summary ROC curve indicates that the areas under the curve were 0.92 (95% CI: 0.89-0.94). In meta-regression analysis, no definite variable was the source of the study heterogeneity. Conclusion The current meta-analysis showed the moderate sensitivity and high specificity of HMGA2 expression for differentiation of malignant thyroid nodules. The likelihood ratio scatter-gram suggested that HMGA2 expression analysis could be useful for confirmation of the presence of malignant thyroid nodules. Considering the heterogeneity of included studies, further large prospective studies are necessary to confirm these results.