Color Doppler ultrasonography diagnostic value in detection of malignant nodules in cysts with pathologically proven thyroid malignancy: a systematic review and meta-analysis

  • L. Darvish
  • M. Khezri
  • S. H. Teshnizi
  • N. Roozbeh
  • J. G. Dehkordi
  • A. AmraeeEmail author
Research Article



Today, the color Doppler ultrasonography is used to further evaluate suspected malignant tumors. This study investigates the malignant thyroid nodules using color Doppler.


After extracting true positive, false positive, false negative, and true negative among included studies, a quality was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (with 95% confidence interval) were found using a random effect model. Summary receiver operating characteristic curves (SROC) were used to assess relationship between sensitivity and specificity. The area under the curve of the SROC was calculated to estimate the performance of color Doppler ultrasound to distinguish malignant thyroid nodules. Our registration code in PROSPERO is CRD42018111198.


Of 1125 articles, 288 articles were selected for the further investigation. After excluding irrelevant and poor articles, 20 studies were included for the meta-analysis. According to a random effect model, the pooled sensitivity and specificity of color Doppler ultrasound to distinguish malignant thyroid nodules were estimated as 0.74 (95% CI 0.62–0.83; \( I^{2} = 89.94\% \)) and 0.70 (95% CI 0.56–0.81; \( I^{2} = 97.79\% \)), respectively. The SROC curve consists of representing the paired results for sensitivity and specificity. According to SROC, AUC = 0.78 (95% CI 0.74–0.81) is between 0.75 and 0.92, so that color Doppler ultrasound has a good accuracy.


Color Doppler is a valuable non-invasive method for evaluating thyroid nodules, and it is a high-sensitivity diagnostic tool for assessing thyroid nodules. Resistive index > 0.75 and a pattern III or more in color Doppler predicts malignant with the confidence. Due to its precision, cost-efficiency, easy access, and non-invasive nature, color Doppler should be included in the standard clinical protocol for the decision-making period and the treatment evaluation.


Color Doppler ultrasound Thyroid nodule Malignant thyroid nodule FNA 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval (research involving human participants and/or animals)

This work has no human or animal participants.

Informed consent

There is no consent for this work.


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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  1. 1.Mother and Child Welfare Research CenterHormozgan University of Medical SciencesBandar AbbasIran
  2. 2.Department of Radiology, Faculty of ParamedicineHormozgan University of Medical SciencesBandar AbbasIran
  3. 3.Hormozgan University of Medical SciencesBandar AbbasIran
  4. 4.Paramedical SchoolHormozgan University of Medical SciencesBandar AbbasIran
  5. 5.Social Determinants of Health Research CenterShahrekord University of Medical SciencesShahrekordIran
  6. 6.Department of Medical Physics, Faculty of Medicine, School of MedicineIran University of Medical SciencesTehranIran

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