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stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng145er15-lrg.png" alt="Cover of Ultrasound guidance for fine needle aspiration" /></a></div><div class="bkr_bib"><h1 id="_NBK577221_"><span itemprop="name">Ultrasound guidance for fine needle aspiration</span></h1><div class="subtitle">Thyroid disease: assessment and management</div><p><b>Evidence review O</b></p><p><i>NICE Guideline, No. 145</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2019 Nov</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3595-6</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div></div><div class="bkr_clear"></div></div><div id="ch15.s1"><h2 id="_ch15_s1_">1. Ultrasound guidance for fine needle aspiration</h2><div id="ch15.s1.1"><h3>1.1. Review question: Should a fine-needle aspiration be under ultrasound guidance?</h3></div><div id="ch15.s1.2"><h3>1.2. Introduction</h3><p>Fine Needle Aspiration (FNA) of the thyroid is a minimally invasive method to obtain tissue for cytological assessment and classification of malignancy risk, commonly using the Royal College of Pathologists grading system (which is similar to the US Bethesda system). The FNA has historically been performed through palpation guidance although in recent years, common practice has seen this become more routinely performed under ultrasound guidance. This latter change in practice has been largely driven in an attempt to reduce the rate of inadequate samples that occur in tissue sampling. It is recognised that while there are specialty society guidelines for practice there are no formal guidelines that demand imaging guided over palpation guided FNA, or vice-versa.</p><p>This review seeks to assess both the evidence base and the cost effectiveness of these two methods of FNA to identify if there is a clinical and/or financial benefit to one over the other.</p></div><div id="ch15.s1.3"><h3>1.3. PICO table</h3><p>For full details see the review protocol in <a href="#ch15.appa">Appendix A</a>:.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch15tab1"><a href="/books/NBK577221/table/ch15.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figch15tab1" rid-ob="figobch15tab1"><img class="small-thumb" src="/books/NBK577221/table/ch15.tab1/?report=thumb" src-large="/books/NBK577221/table/ch15.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="ch15.tab1"><a href="/books/NBK577221/table/ch15.tab1/?report=objectonly" target="object" rid-ob="figobch15tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div><p>As per the full protocol, evidence was extracted preferentially from studies in which at least some of the participants had both UGFNAC and PGFNAC in order to provide the most direct comparative evidence. The committee agreed this evidence was sufficient for decision making.</p><p>The committee noted that while this review was focused on accuracy type data, studies also reported the rates that each testing strategy returned inadequate samples. The committee agreed that the most appropriate way to handle this important information was to extract the ratio of inadequate sampling of each strategy as per an intervention review.</p></div><div id="ch15.s1.4"><h3>1.4. Clinical evidence</h3><div id="ch15.s1.4.1"><h4>1.4.1. Included studies</h4><p>Five studies were included in the review<a class="bibr" href="#ch15.ref11" rid="ch15.ref11"><sup>11</sup></a><sup>,</sup>
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<a class="bibr" href="#ch15.ref18" rid="ch15.ref18"><sup>18</sup></a><sup>,</sup>
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<a class="bibr" href="#ch15.ref21" rid="ch15.ref21"><sup>21</sup></a><sup>,</sup>
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<a class="bibr" href="#ch15.ref46" rid="ch15.ref46"><sup>46</sup></a><sup>,</sup>
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<a class="bibr" href="#ch15.ref50" rid="ch15.ref50"><sup>50</sup></a>; these are summarised in <a class="figpopup" href="/books/NBK577221/table/ch15.tab2/?report=objectonly" target="object" rid-figpopup="figch15tab2" rid-ob="figobch15tab2">Table 2</a> below. Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK577221/table/ch15.tab3/?report=objectonly" target="object" rid-figpopup="figch15tab3" rid-ob="figobch15tab3">Table 3</a>).</p><p>All studies assessed the diagnostic accuracy of UGFNAC compared to PGFNAC using histopathological findings (surgery) as the reference standard. 100% of participants underwent both tests in two studies, with the majority of patients undergoing PGFNAC in two studies while all patients underwent UGFNAC with the minority undergoing both tests in one study. None of the included studies were conducted in Europe. Diagnostic accuracy outcome measures were calculated based on the number of participants for which histopathological data was available in each study.</p><p>See also the study selection flow chart in <a href="#ch15.appc">Appendix C</a>:, sensitivity and specificity forest plots in <a href="#ch15.appe">Appendix E</a>:, and study evidence tables in <a href="#ch15.appd">Appendix D</a>:.</p></div><div id="ch15.s1.4.2"><h4>1.4.2. Excluded studies</h4><p>See the excluded studies list in <a href="#ch15.appi">Appendix I</a>:.</p></div><div id="ch15.s1.4.3"><h4>1.4.3. Summary of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch15tab2"><a href="/books/NBK577221/table/ch15.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figch15tab2" rid-ob="figobch15tab2"><img class="small-thumb" src="/books/NBK577221/table/ch15.tab2/?report=thumb" src-large="/books/NBK577221/table/ch15.tab2/?report=previmg" alt="Table 2. Summary of studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="ch15.tab2"><a href="/books/NBK577221/table/ch15.tab2/?report=objectonly" target="object" rid-ob="figobch15tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review. </p></div></div><p>See <a href="#ch15.appd">appendix D</a> for full evidence tables.</p></div><div id="ch15.s1.4.4"><h4>1.4.4. Quality assessment of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch15tab3"><a href="/books/NBK577221/table/ch15.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figch15tab3" rid-ob="figobch15tab3"><img class="small-thumb" src="/books/NBK577221/table/ch15.tab3/?report=thumb" src-large="/books/NBK577221/table/ch15.tab3/?report=previmg" alt="Table 3. Clinical evidence summary: UGFNAC vs PGFNAC, diagnostic accuracy." /></a><div class="icnblk_cntnt"><h4 id="ch15.tab3"><a href="/books/NBK577221/table/ch15.tab3/?report=objectonly" target="object" rid-ob="figobch15tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: UGFNAC vs PGFNAC, diagnostic accuracy. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch15tab4"><a href="/books/NBK577221/table/ch15.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figch15tab4" rid-ob="figobch15tab4"><img class="small-thumb" src="/books/NBK577221/table/ch15.tab4/?report=thumb" src-large="/books/NBK577221/table/ch15.tab4/?report=previmg" alt="Table 4. Clinical evidence summary: UGFNAC vs PGFNAC, inadequate sample." /></a><div class="icnblk_cntnt"><h4 id="ch15.tab4"><a href="/books/NBK577221/table/ch15.tab4/?report=objectonly" target="object" rid-ob="figobch15tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: UGFNAC vs PGFNAC, inadequate sample. </p></div></div></div></div><div id="ch15.s1.5"><h3>1.5. Economic evidence</h3><div id="ch15.s1.5.1"><h4>1.5.1. Included studies</h4><p>One health economic study with the relevant comparison has been included in this review. <a class="bibr" href="#ch15.ref11" rid="ch15.ref11"><sup>11</sup></a> This is summarised in the health economic evidence profile below (<a class="figpopup" href="/books/NBK577221/table/ch15.tab5/?report=objectonly" target="object" rid-figpopup="figch15tab5" rid-ob="figobch15tab5">Table 5</a>) and the health economic evidence table in <a href="#ch15.appg">Appendix G</a>:.</p></div><div id="ch15.s1.5.2"><h4>1.5.2. Excluded studies</h4><p>One economic study relating to this review question was identified but was excluded due to limited applicability. <a class="bibr" href="#ch15.ref8" rid="ch15.ref8"><sup>8</sup></a>This is listed in <a href="#ch15.appi">appendix I</a>, with reasons for exclusion given.</p><p>See also the health economic study selection flow chart in <a href="#ch15.appf">Appendix F</a>:.</p></div><div id="ch15.s1.5.3"><h4>1.5.3. Summary of studies included in the economic evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch15tab5"><a href="/books/NBK577221/table/ch15.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figch15tab5" rid-ob="figobch15tab5"><img class="small-thumb" src="/books/NBK577221/table/ch15.tab5/?report=thumb" src-large="/books/NBK577221/table/ch15.tab5/?report=previmg" alt="Table 5. Health economic evidence profile: Palpation-guided fine-needle aspiration cytology (PGFNAC) versus Ultrasound-guided fine-needle aspiration cytology (UGFNAC)." /></a><div class="icnblk_cntnt"><h4 id="ch15.tab5"><a href="/books/NBK577221/table/ch15.tab5/?report=objectonly" target="object" rid-ob="figobch15tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Health economic evidence profile: Palpation-guided fine-needle aspiration cytology (PGFNAC) versus Ultrasound-guided fine-needle aspiration cytology (UGFNAC). </p></div></div></div><div id="ch15.s1.5.4"><h4>1.5.4. Health economic modelling</h4><p>This area was prioritised for new cost-effectiveness analysis. The economic analysis was to determine the most cost-effective diagnostic strategy when testing with Fine-Needle Aspiration Cytology (FNAC) to detect thyroid malignancy and treat patients. This will compare the different diagnostic strategies for ultrasound guided FNAC (UGFNAC) and palpation guided FNAC (PGFNAC) with and without repeating tests after a benign diagnosis.</p><p>Thyroid nodules are common, and 4-7% of all thyroid nodules are found to be malignant. After preliminary investigation using clinical evaluation and ultrasound, people presenting with thyroid enlargement receive FNAC where there is a suspicion of thyroid cancer. FNAC is the most accurate and reliable tool for diagnosing thyroid malignancy and it can be performed under palpation guidance (PG) or ultrasound guidance (UG). UG is the more accurate approach but has a higher unit cost.</p><p>Therefore, original cost-effectiveness modelling was undertaken for this question. A summary is included here. Evidence statements summarising the results of the analysis can be found below. The full analysis can be found in Supplement 2.</p><div id="ch15.s1.5.4.1"><h5>1.5.4.1. Methods</h5><p>A cost-consequence analysis was conducted comparing different diagnostic strategies for UGFNAC and PGFNAC. A decision tree was used to estimate short-term benefits and costs from a current UK NHS and personal social services perspective (PSS). In addition, the committee wished to explore the impact of different estimates of prevalence, costs of FNAC for both UG and PG, the cost of surgery and the diagnostic accuracies of the different tests.</p><p>The modelled population was people with an enlarged but normally functioning thyroid gland being investigated for possible malignancy after a positive ultrasound scan (USS).</p><p>The committee agreed that an USS should be the preliminary investigation method to aid decision-making about which nodules to perform FNAC and it is current practice in the UK. The committee noted that only those with U3-U5 grade on USS (U3 indeterminate, U4 suspicious for malignancy, and U5 likely malignant) would be referred for a FNAC and it is these people specifically who are the subject of the model.</p><p>There are different pathways that can be followed when carrying out PGFNAC or UGFNAC tests.</p><p>The following diagnostic strategies were chosen as comparators:
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<ul id="ch15.l2"><li id="ch15.lt3" class="half_rhythm"><div>UGFNAC without repeat after an initial benign diagnosis (‘UGFNAC without benign repeat’);</div></li><li id="ch15.lt4" class="half_rhythm"><div>UGFNAC with repeat after an initial benign diagnosis (‘UGFNAC with benign repeat’);</div></li><li id="ch15.lt5" class="half_rhythm"><div>PGFNAC without repeat after an initial benign diagnosis (‘PGFNAC without benign repeat’);</div></li><li id="ch15.lt6" class="half_rhythm"><div>PGFNAC with repeat after an initial benign diagnosis (‘PGFNAC with benign repeat’).</div></li></ul></p><p>A decision tree was used to calculate the proportion of the population that fall into one of a number of cohorts according to their test result. The decision tree calculates the proportion of patients who will receive a false negative (FN), false positive (FP), true negative (TN), true positive (TP) diagnosis according to the sensitivity, specificity and prevalence data.</p><p>The committee considered that the after FNAC the most likely procedure would be surgery to remove part of the thyroid (hemithyroidectomy) as it can be used as both a diagnostic tool and a treatment. The surgery would identify the true condition.</p><p>Therefore, the outcomes for the FNAC test included in the model to make sure the model reflects the clinical pathway are as follows;
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<ul id="ch15.l3"><li id="ch15.lt7" class="half_rhythm"><div>malignant; Thy5(diagnostic of malignancy) and Thy3F (follicular neoplasm)</div></li><li id="ch15.lt8" class="half_rhythm"><div>benign; Thy2(non-neoplastic)</div></li><li id="ch15.lt9" class="half_rhythm"><div>indeterminate; Thy3A (neoplasm possible with atypical features) and Thy4 (suspicious)</div></li><li id="ch15.lt10" class="half_rhythm"><div>inadequate; Thy1 (non-diagnostic)</div></li></ul></p><p>Patients identified as malignant after a single FNAC are referred directly to surgery. Patients identified as benign are either discharged or referred to a repeat FNAC and this forms part of the variation in the comparators.</p><p>After repeating the FNAC, those patients identified as malignant, indeterminate, and inadequate are referred to surgery. Only those patients identified as benign are discharged.</p><p>In patients with thyroid cancer, the probability that the PG or UG FNAC test is positive (malignancy detected) is determined by the test sensitivity. Therefore, the probability that the test is negative, which means the test failed to detect the malignancy, is 1 – sensitivity.</p><p>To determine the proportion of patients that received a benign, indeterminate, or inadequate test result, a weighted average was calculated using a study that was identified that was included in both the clinical and economic evidence review (Cesur et al 2006).<a class="bibr" href="#ch15.ref2" rid="ch15.ref2"><sup>2</sup></a></p><p>For patients with cancer, a TP result is assigned if they are identified as malignant, indeterminate, or inadequate after their final FNAC. FN results are only assigned to those patients exiting the model as benign.</p><p>In patients who do not have cancer, the probability that FNAC test is negative is determined by the test specificity. For these patients, the probability that the FNAC test is positive is 1 – specificity.</p><p>For patients without cancer, they are assigned as TN status if they receive a benign result for their final FNAC, and therefore are discharged without surgery. FP test results are those that received surgery for thyroid cancer i.e. those patients identified as malignant, indeterminate, or inadequate after their final FNAC.</p><p>For more detailed explanation of the model structure, please refer to the technical report in Supplement 2.</p><p>A number of assumptions were made when developing the model and a sensitivity analyses were undertaken in areas of uncertainty to see how robust the model results are. The sensitivity analyses are outlined below but are also discussed in more detail in Supplement 2:
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<ul id="ch15.l4"><li id="ch15.lt11" class="half_rhythm"><div>cancer prevalence</div></li><li id="ch15.lt12" class="half_rhythm"><div>cost of UGFNAC and PGFNAC</div></li><li id="ch15.lt13" class="half_rhythm"><div>cost of surgery</div></li><li id="ch15.lt14" class="half_rhythm"><div>cost of FN (delayed diagnosis)</div></li><li id="ch15.lt15" class="half_rhythm"><div>ultrasound sensitivity and specificity</div></li><li id="ch15.lt16" class="half_rhythm"><div>UGFNAC sensitivity and specificity</div></li><li id="ch15.lt17" class="half_rhythm"><div>PGFNAC sensitivity and specificity</div></li></ul></p><p>Model inputs were based on clinical evidence identified in the systematic review undertaken for the guideline, supplemented by additional data sources as required. These are described in full in the technical report in Supplement 2. All model inputs and assumptions were validated by the guideline committee, see <a class="figpopup" href="/books/NBK577221/table/ch15.tab6/?report=objectonly" target="object" rid-figpopup="figch15tab6" rid-ob="figobch15tab6">Table 6</a> for a summary of the base case model inputs used in the model.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch15tab6"><a href="/books/NBK577221/table/ch15.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figch15tab6" rid-ob="figobch15tab6"><img class="small-thumb" src="/books/NBK577221/table/ch15.tab6/?report=thumb" src-large="/books/NBK577221/table/ch15.tab6/?report=previmg" alt="Table 6. Summary of the base case model inputs used in the model." /></a><div class="icnblk_cntnt"><h4 id="ch15.tab6"><a href="/books/NBK577221/table/ch15.tab6/?report=objectonly" target="object" rid-ob="figobch15tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Summary of the base case model inputs used in the model. </p></div></div></div><div id="ch15.s1.5.4.2"><h5>1.5.4.2. Results</h5><p>The base-case results are presented below. For a full write up of the model results and sensitivity analyses see Supplement 2.</p><p>UGFNAC without benign repeat <u>was found to be the lowest cost option and had the least false positive results. It was dominant compared to</u> PGFNAC without benign repeat because it detected more cancers at a cheaper cost.</p><p><u>UGFNAC with benign repeat</u> was more effective at detecting cancers and more costly compared to <u>UGFNAC without benign repeat</u> with a cost per extra cancer detected of £74,263.</p><p><u>UGFNAC with benign repeat</u> was dominant compared to <u>PGFNAC with benign repeat</u> as PGFNAC with benign repeat was more costly and less effective in detecting cancer. Results are summarised below in <a class="figpopup" href="/books/NBK577221/table/ch15.tab7/?report=objectonly" target="object" rid-figpopup="figch15tab7" rid-ob="figobch15tab7">Table 7</a>. The incremental costs and true positives from the probabilistic analysis have also been presented graphically on the cost-effectiveness plane, <a class="figpopup" href="/books/NBK577221/figure/ch15.fig1/?report=objectonly" target="object" rid-figpopup="figch15fig1" rid-ob="figobch15fig1">Figure 1</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch15tab7"><a href="/books/NBK577221/table/ch15.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figch15tab7" rid-ob="figobch15tab7"><img class="small-thumb" src="/books/NBK577221/table/ch15.tab7/?report=thumb" src-large="/books/NBK577221/table/ch15.tab7/?report=previmg" alt="Table 7. Base case analysis results per 1000 patients in order of cost (probabilistic analysis)." /></a><div class="icnblk_cntnt"><h4 id="ch15.tab7"><a href="/books/NBK577221/table/ch15.tab7/?report=objectonly" target="object" rid-ob="figobch15tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Base case analysis results per 1000 patients in order of cost (probabilistic analysis). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col fig" id="figch15fig1" co-legend-rid="figlgndch15fig1"><a href="/books/NBK577221/figure/ch15.fig1/?report=objectonly" target="object" title="Figure 1" class="img_link icnblk_img figpopup" rid-figpopup="figch15fig1" rid-ob="figobch15fig1"><img class="small-thumb" src="/books/NBK577221/bin/ch15f1.gif" src-large="/books/NBK577221/bin/ch15f1.jpg" alt="Figure 1. Base case cost-effectiveness plane showing the different diagnostic strategies (probabilistic)." /></a><div class="icnblk_cntnt" id="figlgndch15fig1"><h4 id="ch15.fig1"><a href="/books/NBK577221/figure/ch15.fig1/?report=objectonly" target="object" rid-ob="figobch15fig1">Figure 1</a></h4><p class="float-caption no_bottom_margin">Base case cost-effectiveness plane showing the different diagnostic strategies (probabilistic). </p></div></div><p>Several analyses were run in order to see what effect they had on the cost per cancer detected. This includes prevalence, costs, and the sensitivity and specificity of the different tests.</p><p>One- way sensitivity analyses were run deterministically, and the results are summarised below. These showed that in general, changes in the cost of test or treatment do not result in very different estimates of the cost per cancer detected.</p><p>The PGFNAC without benign repeat versus the UGFNAC without benign repeat, the four analyses that resulted in a change in cost effectiveness were:
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<ul id="ch15.l5"><li id="ch15.lt18" class="half_rhythm"><div>a drop in the cost of PGFNAC;</div></li><li id="ch15.lt19" class="half_rhythm"><div>an increase in the costs of UGFNAC;</div></li><li id="ch15.lt20" class="half_rhythm"><div>increase in the surgery cost; and</div></li><li id="ch15.lt21" class="half_rhythm"><div>a drop in the FN cost.</div></li></ul></p><p>In each case, PGFNAC was no longer dominated but for UGFNAC the additional cost per cancer detected was low.</p><p>The cost per cancer detected for UGFNAC with benign repeat versus UGFNAC without benign repeat was stable with respect to changes of the prevalence and costs.</p><p>In most of the analyses, the PGFNAC with benign repeat was dominated (higher costs and lower true positives) by UGFNAC with benign repeat, except in two analyses where they become less costly and but also detected fewer cancers (true positives). This occurred when
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<ul id="ch15.l6"><li id="ch15.lt22" class="half_rhythm"><div>the cost of UGFNAC increased and</div></li><li id="ch15.lt23" class="half_rhythm"><div>the cost of PGFNAC was reduced.</div></li></ul></p></div><div id="ch15.s1.5.4.3"><h5>1.5.4.3. Limitations and interpretation</h5><p>This analysis suggests that UGFNAC without benign repeat had a relatively low cost per extra cancer for diagnosing thyroid cancer in patients with positive US scan results. Many uncertainties in the model structure and assumptions were explored in sensitivity analyses.</p><p>The primary limitation is the uncertainty around the cost and health consequences of missing a cancer. For simplicity of the model, it was assumed that all FN will re-present later and would be correctly diagnosed as the number of FN that do not re-present or may re-present years later was difficult to model. The committee noted that patients who are US positive and have cancer are more than likely re-present, but the small proportion that might not was difficult to quantify and was not believed to have a substantial effect on the results. However, as the FN costs were consensus based, it was tested in the sensitivity analysis.</p><p>The second limitation of this model is that the diagnostic accuracy data for the US scan was taken from one diagnostic accuracy study. A meta-analysis was discussed but it was decided that for a meaningful meta-analysis, five or more studies were needed. The committee agreed on choosing one study to represent best available evidence, study by Persichetti 201842 that was more representative of UK current practice.</p><p>A third limitation is that it’s unlikely that initial and subsequent tests would be fully independent of one another - for example, sensitivity of UGFNAC is probably less than 90% after an initial negative test result. This means that the cost effectiveness of UGFNAC+ benign repeat vs UGFNAC without benign repeat is likely to be even worse than seen in this analysis.</p><p>A fourth limitation of this model is that some structural assumptions were required with little clinical evidence to allow direct estimates to be made. In particular, it is difficult to test the assumptions made about the suspicious results that were grouped together with the indeterminate (Thy3A) results. The committee had a lengthy discussion to split the group into indeterminate and suspicious but there was no consensus and the clinical evidence did not help quantify this issue. It was therefore agreed that for simplicity of the model, they are to be grouped together.</p></div></div></div><div id="ch15.s1.6"><h3>1.6. Evidence statements</h3><div id="ch15.s1.6.1"><h4>1.6.1. Clinical evidence statements</h4><p>Five studies that evaluated the two diagnostic tests were included in the review. Of these, the committee noted that. The evidence was of low to very low quality.
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<ul id="ch15.l7"><li id="ch15.lt24" class="half_rhythm"><div><b>UGFNAC</b>: Low quality evidence from 5 studies with 750 participants showed that UGFNAC has a specificity of 86% and a sensitivity of 90%.</div></li><li id="ch15.lt25" class="half_rhythm"><div><b>PGFNAC</b>: Very low quality evidence from 5 studies with 750 participants showed that UGFNAC has a specificity of 82% and a sensitivity of 71%.</div></li></ul></p><p>Five studies reported inadequate sample rates. There was no clinically important difference in inadequate sample rates (very low quality).</p></div><div id="ch15.s1.6.2"><h4>1.6.2. Health economic evidence statements</h4><ul id="ch15.l8"><li id="ch15.lt26" class="half_rhythm"><div>One cost-effectiveness analysis found that in adults with nodular goitre, UGFNAC was more costly and more effective than PGFNAC for detecting malignancy (ICER: £1,361 per extra cancer detected). This analysis was assessed as partially applicable with potentially serious limitations.</div></li><li id="ch15.lt27" class="half_rhythm"><div>An original cost-consequence analysis found that
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<dl id="ch15.l9" class="temp-labeled-list"><dl class="bkr_refwrap"><dt>-</dt><dd id="ch15.lt28"><p class="no_top_margin">PGFNAC with a repeat test* was dominated by UGFNAC with a repeat test*</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch15.lt29"><p class="no_top_margin">PGFNAC without a repeat test was dominated by UGFNAC without a repeat test</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch15.lt30"><p class="no_top_margin">UGFNAC with a repeat test* cost an extra £74,263 per extra cancer detected compared to UGFNAC without a repeat test</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch15.lt31"><p class="no_top_margin">*FNAC was repeated after an initial benign test result.</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch15.lt32"><p class="no_top_margin">This was rated as partially applicable with minor limitations.</p></dd></dl></dl></div></li></ul></div></div><div id="ch15.s1.7"><h3>1.7. The committee’s discussion of the evidence</h3><div id="ch15.s1.7.1"><h4>1.7.1. Interpreting the evidence</h4><div id="ch15.s1.7.1.1"><h5>1.7.1.1. The diagnostic measures that matter most</h5><p>The committee considered the diagnostic measures of sensitivity, specificity, positive and negative predictive value of the index tests for diagnosing thyroid cancer. The rate of inadequate sample that each test returned that was reported in the evidence was also considered important by the committee and was therefore taken into account. The sensitivity of tests was deemed the most important measure in this review. There was agreement on the importance of identifying all patients with thyroid cancer and the serious consequences associated with a missed diagnosis of the condition. Thus, sensitivity was prioritised for decision making.</p></div><div id="ch15.s1.7.1.2"><h5>1.7.1.2. The quality of the evidence</h5><p>Clinical evidence for the diagnostic accuracy of UGFNAC and PGFNAC was available from five two gate diagnostic accuracy studies. Evidence for sensitivity and specificity was of low and very low quality for those tests respectively. The evidence for both tests was downgraded due to risk of bias and imprecision. Evidence for the PGFNAC was furthermore downgraded for inconsistency. Clinical evidence for inadequate sample rates was also available from five studies. This was of very low quality due to risk of bias partly because the studies were non-randomised. Overall, the clinical evidence was derived from studies including a total of 750 participants, not all of which had undergone both index tests. In addition, the diagnostic accuracy evidence was based on a limited number of patients for which histopathological confirmation was available.</p><p>The committee noted that the diagnostic accuracy evidence was in regard to palpable nodules that were investigated in the studies included in the present review. The size of nodules was also raised as an important factor that could influence diagnostic accuracy. Specifically, the committee agreed that decision making should ideally be based on the sensitivity and specificity of the tests for small size nodules as well, which was not currently available.</p></div><div id="ch15.s1.7.1.3"><h5>1.7.1.3. Benefits and harms</h5><p>Evidence for the diagnostic accuracy of UGFNAC compared to PGFNAC suggested that for the former index test both measures of sensitivity and specificity were higher. Considering that sensitivity was prioritised for decision making, the considerable discrepancy of almost 20% in sensitivity that was identified between the two tests was noted by the committee.</p><p>Based on the diagnostic accuracy evidence and the inadequate sample results of the index tests and their clinical experience, the committee agreed on offering UGFNAC when performing FNAC for thyroid nodules.</p><p>The committee emphasised an additional benefit associated with ultrasound guidance, in that it can provide information about the sonographic characteristics of a nodule and its malignancy status prior to the use of a needle.</p><p>Evidence suggested no clinically important difference of UGFNAC compared to PGFNAC in terms of inadequate sample. The lower rate of inadequate sample that UGFNAC returned, despite being deemed not clinically important based on the pre-specified cut off (100 per 1000) employed, was noted by the committee and taken into account in decision making. The committee noted that any increase in inadequate samples would lead to an increase in the need for repeat sampling.</p></div></div><div id="ch15.s1.7.2"><h4>1.7.2. Cost effectiveness and resource use</h4><p>One economic analysis was included in the economic literature review that assessed cost effectiveness in terms of cost per cancer avoided from a Turkish perspective. It compared palpation-guided fine-needle aspiration cytology (PGFNAC) with ultrasound-guided fine-needle aspiration cytology (UGFNAC) for the diagnosis of malignancy of thyroid nodules. In addition, original economic analysis was undertaken for this question. This assessed the short-term benefits and costs in terms of cost per cancer avoided from a current UK NHS and personal social services perspective. It compared four different diagnostic strategies for Ultra-sound guided fine-needle aspiration cytology (UGFNAC) and palpation guided fine-needle aspiration cytology (PGFNAC) with and without repeat after a benign diagnosis, which can be followed when carrying out FNAC.</p><p>In the published Turkish analysis, PGFNAC had a slightly lower mean cost per patient (£51) than UGFNAC (£64). The costs included the costs of the thyroid ultrasonography, PGFNAC, UGFNAC and cytologic examinations. It was also less effective with a true positive rate of 1.89% compared to 2.79%. The incremental cost effectiveness ratio for UGFNAC compared to PGNAC was £1,361 per extra cancer detected. The study was assessed as partially applicable as it did not utilise an NHS perspective and used unit costs from a Turkish health service (state and private hospital) perspective in 2006. The study also did not report outcomes in terms of QALYs. It was also assessed to have potentially serious limitations as the estimates of relative treatment effects are based on the single study of 215 patients and not based on meta-analysis of all the available evidence identified in the clinical review for the guideline. Some costs were taken from private hospitals and may be overestimated. Additionally, no sensitivity analysis was undertaken to adequately assess parameter uncertainty.</p><p>Original modelling was done for this review because of the potentially serious limitations and partial applicability of the Turkish analysis, and because UGFNAC appeared more costly and more effective than PGFNAC. An original cost-consequence analysis found that UGFNAC without benign repeat was the cheapest option and was dominant compared to the PGFNAC without benign repeat (less costly and more effective in detecting cancer). PGFNAC with benign repeat was dominated by UGFNAC with benign repeat, as it is less costly and more effective at detecting cancer. The committee noted that the UGFNAC with benign repeat is unlikely to be cost effective compared to UGFNAC without benign repeat as the cost per extra cancer detected £74,263, was considered relatively high. The committee concluded that UGFNAC without benign repeat is also better then UGFNAC with benign repeat, because it results in less false negatives. This will reduce costs but also improve patient’s quality of life.</p><p>Furthermore, the committee was aware of the issues associated with late versus early detection of cancer (malignancy). They noted that earlier detection has a higher chance of survival compared to late detection or undetected cancers, which could mean a lost chance of treatment to the patient, increased risk of complications and mortality. Late detection will incur additional costs and reduce quality of life.</p><p>This supported a strong recommendation to offer UGFNAC for the diagnosis of malignancy in thyroid nodules. The committee noted that the results of the economic evidence and the original cost-analysis were in line with current practice and were not likely to have a substantial cost impact.</p></div><div id="ch15.s1.7.3"><h4>1.7.3. Other factors the committee took into account</h4><p>The committee noted that while they would generally recommend ultrasound guidance for FNAC, there may be the occasional scenario in which clinical features are highly suggestive of malignancy and the potential delay in obtaining an ultrasound guided FNAC (as opposed to a palpation guided FNAC which could be done in the initial assessment appointment) may not be warranted as the key issue would be to begin management as soon as possible. However, they agreed that ideally an urgent UG FNAC would be available and avoid the need for PG FNAC at any point.</p></div></div></div><div id="ch15.rl.r1"><h2 id="_ch15_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="ch15.ref1">Aksu
|
|
O, Koroglu
|
|
BK, Ersoy
|
|
IH, Koroglu
|
|
M, Ciris
|
|
M, Ersoy
|
|
S
|
|
et al. Thyroid fine needle aspiration biopsy: Which method should be preferred in an endemic goiter region?
|
|
Acta Medica Mediterranea. 2014; 30(1):297–301</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="ch15.ref2">Al Maqbali
|
|
T, Tedla
|
|
M, Weickert
|
|
MO, Mehanna
|
|
H. Malignancy risk analysis in patients with inadequate fine needle aspiration cytology (FNAC) of the thyroid. PloS One. 2012; 7(11):e49078 [<a href="/pmc/articles/PMC3501514/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3501514</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23185295" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23185295</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="ch15.ref3">Bohacek
|
|
L, Milas
|
|
M, Mitchell
|
|
J, Siperstein
|
|
A, Berber
|
|
E. Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules. Annals of Surgical Oncology. 2012; 19(1):45–51 [<a href="https://pubmed.ncbi.nlm.nih.gov/21633868" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21633868</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="ch15.ref4">Borget
|
|
I, Vielh
|
|
P, Leboulleux
|
|
S, Allyn
|
|
M, Iacobelli
|
|
S, Schlumberger
|
|
M
|
|
et al. Assessment of the cost of fine-needle aspiration cytology as a diagnostic tool in patients with thyroid nodules. American Journal of Clinical Pathology. 2008; 129(5):763–771 [<a href="https://pubmed.ncbi.nlm.nih.gov/18426737" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18426737</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="ch15.ref5">Braga
|
|
M, Cavalcanti
|
|
TC, Collaco
|
|
LM, Graf
|
|
H. Efficacy of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of complex thyroid nodules. Journal of Clinical Endocrinology and Metabolism. 2001; 86(9):4089–4091 [<a href="https://pubmed.ncbi.nlm.nih.gov/11549630" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11549630</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="ch15.ref6">Cai
|
|
XJ, Valiyaparambath
|
|
N, Nixon
|
|
P, Waghorn
|
|
A, Giles
|
|
T, Helliwell
|
|
T. Ultrasound-guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules. Cytopathology. 2006; 17(5):251–256 [<a href="https://pubmed.ncbi.nlm.nih.gov/16961653" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16961653</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="ch15.ref7">Cam
|
|
OH, Tekin
|
|
M, Acar
|
|
GO, Kilicaslan
|
|
A. What is the Role of Diffusion Weigh Magnetic Resonance Imaging in Evaluation of Thyroid Nodules?
|
|
Indian Journal of Otolaryngology & Head & Neck Surgery. 2014; 66(3):336–340 [<a href="/pmc/articles/PMC4071433/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4071433</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25032125" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25032125</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="ch15.ref8">Can
|
|
AS. Cost-effectiveness comparison between palpation- and ultrasound-guided thyroid fine-needle aspiration biopsies. BMC Endocrine Disorders. 2009; 9(14) [<a href="/pmc/articles/PMC2688006/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2688006</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19445710" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19445710</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="ch15.ref9">Can
|
|
AS, Peker
|
|
K. Comparison of palpation-versus ultrasound-guided fine-needle aspiration biopsies in the evaluation of thyroid nodules. BMC Research Notes. 2008; 1:12 [<a href="/pmc/articles/PMC2518275/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2518275</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18710537" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18710537</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="ch15.ref10">Carmeci
|
|
C, Jeffrey
|
|
RB, McDougall
|
|
IR, Nowels
|
|
KW, Weigel
|
|
RJ. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses. Thyroid. 1998; 8(4):283–289 [<a href="https://pubmed.ncbi.nlm.nih.gov/9588492" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9588492</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="ch15.ref11">Cesur
|
|
M, Corapcioglu
|
|
D, Bulut
|
|
S, Gursoy
|
|
A, Yilmaz
|
|
AE, Erdogan
|
|
N
|
|
et al. Comparison of palpation-guided fine-needle aspiration biopsy to ultrasound-guided fine-needle aspiration biopsy in the evaluation of thyroid nodules. Thyroid. 2006; 16(6):555–561 [<a href="https://pubmed.ncbi.nlm.nih.gov/16839257" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16839257</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="ch15.ref12">Danese
|
|
D, Sciacchitano
|
|
S, Farsetti
|
|
A, Andreoli
|
|
M, Pontecorvi
|
|
A. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid. 1998; 8(1):15–21 [<a href="https://pubmed.ncbi.nlm.nih.gov/9492148" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9492148</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="ch15.ref13">de Meer
|
|
SG, Schreinemakers
|
|
JM, Zelissen
|
|
PM, Stapper
|
|
G, Sie-Go
|
|
DM, Rinkes
|
|
IH
|
|
et al. Fine-needle aspiration of thyroid tumors: identifying factors associated with adequacy rate in a large academic center in the Netherlands. Diagnostic Cytopathology. 2012; 40 (Suppl 1):E21–E26 [<a href="https://pubmed.ncbi.nlm.nih.gov/22619155" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22619155</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="ch15.ref14">Deandrea
|
|
M, Mormile
|
|
A, Veglio
|
|
M, Motta
|
|
M, Pellerito
|
|
R, Gallone
|
|
G
|
|
et al. Fine-needle aspiration biopsy of the thyroid: Comparison between thyroid palpation and ultrasonography. Endocrine Practice. 2002; 8(4):282–286 [<a href="https://pubmed.ncbi.nlm.nih.gov/12185993" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12185993</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="ch15.ref15">Esfahanian
|
|
F, Aryan
|
|
A, Ghajarzadeh
|
|
M, Yazdi
|
|
MH, Nobakht
|
|
N, Burchi
|
|
M. Application of sonoelastography in differential diagnosis of benign and malignant thyroid nodules. International Journal of Preventive Medicine. 2016; 7(1):55 [<a href="/pmc/articles/PMC4809115/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4809115</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27076893" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27076893</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="ch15.ref16">Hatada
|
|
T, Okada
|
|
K, Ishii
|
|
H, Ichii
|
|
S, Utsunomiya
|
|
J. Evaluation of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules. American Journal of Surgery. 1998; 175(2):133–136 [<a href="https://pubmed.ncbi.nlm.nih.gov/9515530" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9515530</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="ch15.ref17">Izquierdo
|
|
R, Arekat
|
|
MR, Knudson
|
|
PE, Kartun
|
|
KF, Khurana
|
|
K, Kort
|
|
K
|
|
et al. Comparison of palpation-guided versus ultrasound-guided fine-needle aspiration biopsies of thyroid nodules in an outpatient endocrinology practice. Endocrine Practice. 2006; 12(6):609–614 [<a href="https://pubmed.ncbi.nlm.nih.gov/17229656" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17229656</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="ch15.ref18">Jalan
|
|
S, Sengupta
|
|
S, Ray
|
|
R, Mondal
|
|
R, Phukan
|
|
J, Bardhan
|
|
J
|
|
et al. A comparative evaluation of USG-guided FNAC with conventional FNAC in the preoperative assessment of thyroid lesions: A particular reference to cyto-histologically discordant cases. Bangladesh Journal of Medical Science. 2017; 16(2):274–281</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="ch15.ref19">Kawai
|
|
T, Nishihara
|
|
E, Kudo
|
|
T, Ota
|
|
H, Morita
|
|
S, Kobayashi
|
|
K
|
|
et al. Histopathological diagnoses of “accessory” thyroid nodules diagnosed as benign by fine-needle aspiration cytology and ultrasonography. Thyroid. 2012; 22(3):299–303 [<a href="https://pubmed.ncbi.nlm.nih.gov/22300250" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22300250</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="ch15.ref20">Kimoto
|
|
T, Suemitsu
|
|
K, Eda
|
|
I, Shimizu
|
|
T, Ohtani
|
|
M, Nabika
|
|
T. The efficiency of performing ultrasound-guided fine-needle aspiration biopsy following mass screening for thyroid tumors to avoid unnecessary surgery. Surgery Today. 1999; 29(9):880–883 [<a href="https://pubmed.ncbi.nlm.nih.gov/10489129" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10489129</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="ch15.ref21">Krishnappa
|
|
P, Ramakrishnappa
|
|
S, Kulkarni
|
|
MH. Comparison of free hand versus ultrasound-guided fine needle aspiration of thyroid with histopathological correlation. Journal of Environmental Pathology, Toxicology and Oncology. 2013; 32(2):149–155 [<a href="https://pubmed.ncbi.nlm.nih.gov/24099428" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24099428</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="ch15.ref22">Lee
|
|
J, Lee
|
|
SY, Cha
|
|
SH, Cho
|
|
BS, Kang
|
|
MH, Lee
|
|
OJ. Fine-needle aspiration of thyroid nodules with macrocalcification. Thyroid. 2013; 23(9):1106–1112 [<a href="https://pubmed.ncbi.nlm.nih.gov/23311668" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23311668</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="ch15.ref23">Lee
|
|
SW, Lee
|
|
HJ, Kim
|
|
HJ, Lee
|
|
J, Park
|
|
JY, Kim
|
|
SH
|
|
et al. Combined categorical reporting systems of US and cytology findings for thyroid nodules: guidance on repeat fine-needle aspiration cytology. Radiology. 2013; 266(3):956–963 [<a href="https://pubmed.ncbi.nlm.nih.gov/23220892" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23220892</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="ch15.ref24">Lee
|
|
YH, Kim
|
|
BH, Suh
|
|
SI, Seo
|
|
HS, Seo
|
|
BK, Cho
|
|
KR
|
|
et al. Comparison of cytological results obtained by repeated US-guided fine-needle aspiration biopsies of thyroid nodules: focus on the rate of malignancy and diagnostic concordance. Diagnostic Cytopathology. 2009; 37(7):492–497 [<a href="https://pubmed.ncbi.nlm.nih.gov/19217058" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19217058</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="ch15.ref25">Leung
|
|
VA, Kirpalani
|
|
A, Mnatzakanian
|
|
G, Colak
|
|
E, Vlachou
|
|
PA. Effect of a Biopsy Center on Adequacy Rates of Thyroid Nodule Fine-Needle Aspiration. AJR American Journal of Roentgenology. 2017; 209(2):358–362 [<a href="https://pubmed.ncbi.nlm.nih.gov/28570128" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28570128</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="ch15.ref26">Lew
|
|
JI, Rodgers
|
|
SE, Solorzano
|
|
CC. Developments in the use of ultrasound for thyroid cancer. Current Opinion in Oncology. 2010; 22(1):11–16 [<a href="https://pubmed.ncbi.nlm.nih.gov/19864951" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19864951</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="ch15.ref27">Li
|
|
C, Zhan
|
|
W, Yi
|
|
F, Zheng
|
|
B, Zhou
|
|
Y, Zhao
|
|
R
|
|
et al. Fine needle aspiration cytology guided by ultrasound in the diagnosis of subcentimetre thyroid nodules. Springerplus. 2016; 5:876 [<a href="/pmc/articles/PMC4920789/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4920789</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27386325" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27386325</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="ch15.ref28">Lin
|
|
JD, Huang
|
|
BY, Weng
|
|
HF, Jeng
|
|
LB, Hsueh
|
|
C. Thyroid ultrasonography with fine-needle aspiration cytology for the diagnosis of thyroid cancer. Journal of Clinical Ultrasound. 1997; 25(3):111–118 [<a href="https://pubmed.ncbi.nlm.nih.gov/9058259" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9058259</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="ch15.ref29">Mehrotra
|
|
P, Viswanathan
|
|
H, Johnson
|
|
SJ, Wadehra
|
|
V, Richardson
|
|
DL, Lennard
|
|
TW. Ultrasound guidance improves the adequacy of our preoperative thyroid cytology but not its accuracy. Cytopathology. 2006; 17(3):137–144 [<a href="https://pubmed.ncbi.nlm.nih.gov/16719856" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16719856</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="ch15.ref30">Melany
|
|
M, Chen
|
|
S. Thyroid Cancer: Ultrasound Imaging and Fine-Needle Aspiration Biopsy. Endocrinology and Metabolism Clinics of North America. 2017; 46(3):691–711 [<a href="https://pubmed.ncbi.nlm.nih.gov/28760234" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28760234</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="ch15.ref31">Mirshemirani
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A, Roshanzamir
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F, Tabari
|
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AK, Ghorobi
|
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J, Salehpoor
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S, Gorji
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FA. Thyroid nodules in childhood: a single institute experience. Iranian Journal of Pediatrics. 2010; 20(1):91–96 [<a href="/pmc/articles/PMC3446001/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3446001</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23056688" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23056688</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="ch15.ref32">Mittendorf
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EA, Tamarkin
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SW, McHenry
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CR. The results of ultrasound-guided fine-needle aspiration biopsy for evaluation of nodular thyroid disease. Surgery. 2002; 132(4):648–653; discussion 653-4 [<a href="https://pubmed.ncbi.nlm.nih.gov/12407349" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12407349</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="ch15.ref33">Moon
|
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HG, Jung
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EJ, Park
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ST, Ha
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WS, Choi
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SK, Hong
|
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SC
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et al. Role of ultrasonography in predicting malignancy in patients with thyroid nodules. World Journal of Surgery. 2007; 31(7):1410–1416 [<a href="https://pubmed.ncbi.nlm.nih.gov/17534557" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17534557</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="ch15.ref34">Muruganandham
|
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K, Sistla
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SC, Elangovan
|
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S, Verma
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SK. Routine ultrasound-guided aspiration cytology for evaluation of palpable thyroid nodules in an endemic area: is it justified?
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Journal of otolaryngology - head & neck surgery. 2009; 38(2):222–226 [<a href="https://pubmed.ncbi.nlm.nih.gov/19442372" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19442372</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="ch15.ref35">Nachiappan
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AC, Metwalli
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ZA, Hailey
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BS, Patel
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RA, Ostrowski
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ML, Wynne
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DM. The thyroid: review of imaging features and biopsy techniques with radiologic-pathologic correlation. Radiographics. 2014; 34(2):276–293 [<a href="https://pubmed.ncbi.nlm.nih.gov/24617678" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24617678</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="ch15.ref36">Nam-Goong
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IS, Kim
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HY, Gong
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G, Lee
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HK, Hong
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SJ, Kim
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WB
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et al. Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clinical Endocrinology. 2004; 60(1):21–28 [<a href="https://pubmed.ncbi.nlm.nih.gov/14678283" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14678283</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="ch15.ref37">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [updated October 2018]. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a></div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="ch15.ref38">Newkirk
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KA, Ringel
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MD, Jelinek
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J, Mark
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A, Wartofsky
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L, Deeb
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ZE
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et al. Ultrasound-guided fine-needle aspiration and thyroid disease. Otolaryngology - Head & Neck Surgery. 2000; 123(6):700–705 [<a href="https://pubmed.ncbi.nlm.nih.gov/11112961" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11112961</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="ch15.ref39">Ogawa
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Y, Kato
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Y, Ikeda
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K, Aya
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M, Ogisawa
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K, Kitani
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K
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et al. The value of ultrasound-guided fine-needle aspiration cytology for thyroid nodules: an assessment of its diagnostic potential and pitfalls. Surgery Today. 2001; 31(2):97–101 [<a href="https://pubmed.ncbi.nlm.nih.gov/11291721" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11291721</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="ch15.ref40">Organisation for Economic Co-operation and Development (OECD). Purchasing power parities (PPP). 2012. Available from: <a href="http://www.oecd.org/std/ppp" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.oecd.org/std/ppp</a> Last accessed: 15/02/2019</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="ch15.ref41">Peng
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L, Gu
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MJ. Diagnostic value of conventional and ultrasound-guided fine-needle aspiration biopsy for thyroid nodules: a meta-analysis. Academic Journal of Second Military Medical University. 2007; 28(9):968–972</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="ch15.ref42">Persichetti
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A, Di Stasio
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E, Guglielmi
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R, Bizzarri
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G, Taccogna
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S, Misischi
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I
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et al. Predictive Value of Malignancy of Thyroid Nodule Ultrasound Classification Systems: A Prospective Study. Journal of Clinical Endocrinology and Metabolism. 2018; 103(4):1359–1368 [<a href="https://pubmed.ncbi.nlm.nih.gov/29408952" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29408952</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="ch15.ref43">Rorive
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S, D’Haene
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N, Fossion
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C, Delpierre
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I, Abarguia
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N, Avni
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F
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et al. Ultrasound-guided fine-needle aspiration of thyroid nodules: stratification of malignancy risk using follicular proliferation grading, clinical and ultrasonographic features. European Journal of Endocrinology. 2010; 162(6):1107–1115 [<a href="https://pubmed.ncbi.nlm.nih.gov/20219856" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20219856</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="ch15.ref44">Schwartz
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J, How
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J, Lega
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I, Cote
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J, Gologan
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O, Rivera
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JA
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et al. Ultrasound-guided fine-needle aspiration thyroid biopsies in the otolaryngology clinic. Journal of Otolaryngology - Head and Neck Surgery. 2010; 39(4):356–360 [<a href="https://pubmed.ncbi.nlm.nih.gov/20642999" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20642999</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="ch15.ref45">Singh Ospina
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N, Brito
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JP, Maraka
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S, Espinosa de Ycaza
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AE, Rodriguez-Gutierrez
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R, Gionfriddo
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MR
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et al. Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for thyroid malignancy: systematic review and meta-analysis. Endocrine. 2016; 53(3):651–661 [<a href="https://pubmed.ncbi.nlm.nih.gov/27071659" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27071659</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>46.</dt><dd><div class="bk_ref" id="ch15.ref46">Takashima
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S, Fukuda
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H, Kobayashi
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T. Thyroid nodules: clinical effect of ultrasound-guided fine-needle aspiration biopsy. Journal of Clinical Ultrasound. 1994; 22(9):535–42 [<a href="https://pubmed.ncbi.nlm.nih.gov/7806661" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7806661</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="ch15.ref47">Witt
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RL, Sukumar
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VR, Gerges
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F. Surgeon-performed ultrasound-guided FNAC with on-site cytopathology improves adequacy and accuracy. Laryngoscope. 2015; 125(7):1633–1636 [<a href="https://pubmed.ncbi.nlm.nih.gov/25703413" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25703413</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>48.</dt><dd><div class="bk_ref" id="ch15.ref48">Yang
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GC, Liebeskind
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D, Messina
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AV. Ultrasound-guided fine-needle aspiration of the thyroid assessed by Ultrafast Papanicolaou stain: data from 1135 biopsies with a two- to six-year follow-up. Thyroid. 2001; 11(6):581–589 [<a href="https://pubmed.ncbi.nlm.nih.gov/11442006" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11442006</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="ch15.ref49">Young
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JK, Lumapas
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CG, Mirasol
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R. Sonographically guided fine-needle aspiration biopsy of thyroid nodules: Correlation between cytologic and histopathologic findings. Phillippine Journal of Internal Medicine. 2011; 49(1):8–14</div></dd></dl><dl class="bkr_refwrap"><dt>50.</dt><dd><div class="bk_ref" id="ch15.ref50">Zawawi
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F, Mosli
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MH, Zawawi
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ST. Should ultrasound-guided fine needle aspiration be considered a first-line technique in assessing a thyroid nodule?
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Otolaryngologia Polska. 2016; 70(1):49–53 [<a href="https://pubmed.ncbi.nlm.nih.gov/26926308" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26926308</span></a>]</div></dd></dl></dl></div><div id="appendixesappgroup15"><h2 id="_appendixesappgroup15_">Appendices</h2><div id="ch15.appa"><h3>Appendix A. Review protocols</h3><p id="ch15.appa.tab1"><a href="/books/NBK577221/table/ch15.appa.tab1/?report=objectonly" target="object" rid-ob="figobch15appatab1" class="figpopup">Table 8. Table</a></p><p id="ch15.appa.tab2"><a href="/books/NBK577221/table/ch15.appa.tab2/?report=objectonly" target="object" rid-ob="figobch15appatab2" class="figpopup">Table 9. Health economic review protocol</a></p></div><div id="ch15.appb"><h3>Appendix B. Literature search strategies</h3><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual 2014, updated 2018</p><p>
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<a href="https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869</a>
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</p><p><i>For more detailed information, please see the</i> Methodology <i>Review</i>.</p><div id="ch15.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p>Searches were constructed using a PICO framework where population (P) terms were combined with Intervention (I) and in some cases Comparison (C) terms. Outcomes (O) are rarely used in search strategies for interventions as these concepts may not be well described in title, abstract or indexes and therefore difficult to retrieve. Search filters were applied to the search where appropriate.</p><p id="ch15.appb.tab1"><a href="/books/NBK577221/table/ch15.appb.tab1/?report=objectonly" target="object" rid-ob="figobch15appbtab1" class="figpopup">Table 10. Database date parameters and filters used</a></p><p id="ch15.appb.tab2"><a href="/books/NBK577221/table/ch15.appb.tab2/?report=objectonly" target="object" rid-ob="figobch15appbtab2" class="figpopup">Medline (Ovid) search terms</a></p><p id="ch15.appb.tab3"><a href="/books/NBK577221/table/ch15.appb.tab3/?report=objectonly" target="object" rid-ob="figobch15appbtab3" class="figpopup">Embase (Ovid) search terms</a></p><p id="ch15.appb.tab4"><a href="/books/NBK577221/table/ch15.appb.tab4/?report=objectonly" target="object" rid-ob="figobch15appbtab4" class="figpopup">Cochrane Library (Wiley) search terms</a></p></div><div id="ch15.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p>Health economic evidence was identified by conducting a broad search relating to a thyroid disease population in NHS Economic Evaluation Database (NHS EED – this ceased to be updated after March 2015) and the Health Technology Assessment database (HTA) with no date restrictions. NHS EED and HTA databases are hosted by the Centre for Research and Dissemination (CRD). Additional searches were run on Medline and Embase for health economics, economic modelling and quality of life studies.</p><p id="ch15.appb.tab5"><a href="/books/NBK577221/table/ch15.appb.tab5/?report=objectonly" target="object" rid-ob="figobch15appbtab5" class="figpopup">Table 11. Database date parameters and filters used</a></p><p id="ch15.appb.tab6"><a href="/books/NBK577221/table/ch15.appb.tab6/?report=objectonly" target="object" rid-ob="figobch15appbtab6" class="figpopup">Medline (Ovid) search terms</a></p><p id="ch15.appb.tab7"><a href="/books/NBK577221/table/ch15.appb.tab7/?report=objectonly" target="object" rid-ob="figobch15appbtab7" class="figpopup">Embase (Ovid) search terms</a></p><p id="ch15.appb.tab8"><a href="/books/NBK577221/table/ch15.appb.tab8/?report=objectonly" target="object" rid-ob="figobch15appbtab8" class="figpopup">NHS EED and HTA (CRD) search terms</a></p></div></div><div id="ch15.appc"><h3>Appendix C. Clinical evidence selection</h3><p id="ch15.appc.fig1"><a href="/books/NBK577221/figure/ch15.appc.fig1/?report=objectonly" target="object" rid-ob="figobch15appcfig1" class="figpopup">Figure 2. Flow chart of clinical study selection for the review of FNAB with or without ultrasound</a></p></div><div id="ch15.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="ch15.appd.et1"><a href="/books/NBK577221/bin/ch15-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (262K)</span></p></div><div id="ch15.appe"><h3>Appendix E. Coupled sensitivity and specificity forest plots and sROC curves</h3><div id="ch15.appe.s1"><h4>E.1. Coupled sensitivity and specificity forest plots</h4><p id="ch15.appe.fig1"><a href="/books/NBK577221/figure/ch15.appe.fig1/?report=objectonly" target="object" rid-ob="figobch15appefig1" class="figpopup">Figure 3. UGFNAC</a></p><p id="ch15.appe.fig2"><a href="/books/NBK577221/figure/ch15.appe.fig2/?report=objectonly" target="object" rid-ob="figobch15appefig2" class="figpopup">Figure 4. PGFNAC</a></p></div><div id="ch15.appe.s2"><h4>E.2. Inadequate results</h4><p id="ch15.appe.fig3"><a href="/books/NBK577221/figure/ch15.appe.fig3/?report=objectonly" target="object" rid-ob="figobch15appefig3" class="figpopup">Figure 5. Inadequate results</a></p></div></div><div id="ch15.appf"><h3>Appendix F. Health economic evidence selection</h3><p id="ch15.appf.fig1"><a href="/books/NBK577221/figure/ch15.appf.fig1/?report=objectonly" target="object" rid-ob="figobch15appffig1" class="figpopup">Figure 6. Flow chart of health economic study selection for the guideline</a></p></div><div id="ch15.appg"><h3>Appendix G. Health economic evidence tables</h3><p id="ch15.appg.et1"><a href="/books/NBK577221/bin/ch15-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (174K)</span></p></div><div id="ch15.apph"><h3>Appendix H. Health economic analysis</h3><p>None</p></div><div id="ch15.appi"><h3>Appendix I. Excluded studies</h3><div id="ch15.appi.s1"><h4>I.1. Excluded clinical studies</h4><p id="ch15.appi.tab1"><a href="/books/NBK577221/table/ch15.appi.tab1/?report=objectonly" target="object" rid-ob="figobch15appitab1" class="figpopup">Table 12. Studies excluded from the clinical review</a></p></div><div id="ch15.appi.s2"><h4>I.2. Excluded health economic studies</h4><p id="ch15.appi.tab2"><a href="/books/NBK577221/table/ch15.appi.tab2/?report=objectonly" target="object" rid-ob="figobch15appitab2" class="figpopup">Table 13. Studies excluded from the health economic review</a></p></div></div></div></div><div class="fm-sec"><div><p>FINAL</p></div><div><p>Diagnostic evidence review underpinning recommendations 1.9.1 to 1.9.6 in the guideline. See also evidence review N</p><p>Developed by the National Guideline Centre, hosted by the Royal College of Physicians</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and, where appropriate, their carer or guardian.</p><p>Local commissioners and providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div><div class="small"><span class="label">Bookshelf ID: NBK577221</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35129918" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35129918</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobch15tab1"><div id="ch15.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_ch15.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_ch15.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with thyroid nodules</td></tr><tr><th id="hd_b_ch15.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Target condition</th><td headers="hd_b_ch15.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Malignancy</td></tr><tr><th id="hd_b_ch15.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index test Comparator</th><td headers="hd_b_ch15.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Ultrasound guided fine needle aspiration cytology (UGFNAC)</p>
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<p>Palpation guided fine needle aspiration cytology (PGFNAC)</p>
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</td></tr><tr><th id="hd_b_ch15.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard</th><td headers="hd_b_ch15.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnosis of malignancy on core biopsy or later surgery</td></tr><tr><th id="hd_b_ch15.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Statistical measures Outcomes</th><td headers="hd_b_ch15.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Sensitivity</p>
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<p>Specificity</p>
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<p>Inadequate sample (dichotomous)</p>
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</td></tr><tr><th id="hd_b_ch15.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_ch15.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic accuracy studies</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch15tab2"><div id="ch15.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch15.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_ch15.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_ch15.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Target condition</th><th id="hd_h_ch15.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Index tests</th><th id="hd_h_ch15.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Reference standard</th><th id="hd_h_ch15.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_ch15.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cesur 2006 <a class="bibr" href="#ch15.ref11" rid="ch15.ref11"><sup>11</sup></a></td><td headers="hd_h_ch15.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults: n=215, mean age (SD) 48.7 (13.5) with 1-3 palpable nodules (diameter: 1 - 2.5 cm)</p>
|
|
<p>Turkey</p>
|
|
</td><td headers="hd_h_ch15.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thyroid cancer</td><td headers="hd_h_ch15.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>UGFNAC</p>
|
|
<p>PGFNAC</p>
|
|
<p>100 % of patients underwent both tests</p>
|
|
</td><td headers="hd_h_ch15.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Histopathology</td><td headers="hd_h_ch15.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgery performed in 13 patients (26 nodules)</td></tr><tr><td headers="hd_h_ch15.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jalan 2017 <a class="bibr" href="#ch15.ref18" rid="ch15.ref18"><sup>18</sup></a></td><td headers="hd_h_ch15.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Patients: n=84, age range 8-71; UG findings available in n=36</p>
|
|
<p>India</p>
|
|
</td><td headers="hd_h_ch15.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thyroid cancer</td><td headers="hd_h_ch15.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>UGFNAC</p>
|
|
<p>PGFNAC</p>
|
|
<p>43% (n=36) gave consent for both tests, 57% (n=48) underwent PGFNAC only</p>
|
|
</td><td headers="hd_h_ch15.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Histopathology</td><td headers="hd_h_ch15.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Histopathology was available in 40 cases (18 from PGFNA, 22 from combined PG-& UG-FNA)</td></tr><tr><td headers="hd_h_ch15.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Krishnappa 2013 <a class="bibr" href="#ch15.ref21" rid="ch15.ref21"><sup>21</sup></a></td><td headers="hd_h_ch15.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Patients: n=91, mean age (range) 38.5 (8-80);</p>
|
|
<p>83.5% euthyroid, 16.5% signs and symptoms of hyperthyroidism, 3.3% previous thyroid surgery</p>
|
|
<p>India</p>
|
|
</td><td headers="hd_h_ch15.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thyroid cancer</td><td headers="hd_h_ch15.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>UGFNAC</p>
|
|
<p>PGFNAC</p>
|
|
<p>100 % of patients underwent both tests</p>
|
|
</td><td headers="hd_h_ch15.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Histopathology</td><td headers="hd_h_ch15.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgery performed in 25 patients</td></tr><tr><td headers="hd_h_ch15.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Takashima 1994 <a class="bibr" href="#ch15.ref46" rid="ch15.ref46"><sup>46</sup></a></td><td headers="hd_h_ch15.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Patients: n=210, mean age (range) 53 (12-88); 268 aspirated nodules</p>
|
|
<p>Japan</p>
|
|
</td><td headers="hd_h_ch15.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thyroid cancer</td><td headers="hd_h_ch15.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>UGFNAC</p>
|
|
<p>PGFNAC</p>
|
|
<p>27% (n=57) of patients underwent both tests, all had UGFNAC</p>
|
|
</td><td headers="hd_h_ch15.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Histopathology</td><td headers="hd_h_ch15.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Histopathologic confirmation in 34 patients (62 nodules)</p>
|
|
<p>Thyroid disease n=72, neck radiation therapy or surgery or both n=15, history of cancer at other site n=22</p>
|
|
</td></tr><tr><td headers="hd_h_ch15.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zawawi 2016 <a class="bibr" href="#ch15.ref50" rid="ch15.ref50"><sup>50</sup></a></td><td headers="hd_h_ch15.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Patients: n=150, mean age 41.6; 183 FNAs</p>
|
|
<p>Saudi Arabia</p>
|
|
</td><td headers="hd_h_ch15.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thyroid cancer</td><td headers="hd_h_ch15.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>UGFNAC</p>
|
|
<p>PGFNAC</p>
|
|
<p>77 UGFNACs, 151 PGFNACs; unclear number of patients undergoing both tests.</p>
|
|
</td><td headers="hd_h_ch15.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Histopathology</td><td headers="hd_h_ch15.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear availability of histopathological confirmation</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch15tab3"><div id="ch15.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: UGFNAC vs PGFNAC, diagnostic accuracy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch15.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Index Test (Threshold)</th><th id="hd_h_ch15.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th id="hd_h_ch15.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">n</th><th id="hd_h_ch15.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_ch15.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Specificity % (95% CI)</th><th id="hd_h_ch15.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sensitivity % (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch15.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">UGFNAC</td><td headers="hd_h_ch15.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_ch15.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">750</td><td headers="hd_h_ch15.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LOW<sup>a</sup><sup>,</sup><sup>c</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch15.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">86 (72 to 96)</td><td headers="hd_h_ch15.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">90 (76 to 98)</td></tr><tr><td headers="hd_h_ch15.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PGFNAC</td><td headers="hd_h_ch15.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">5</td><td headers="hd_h_ch15.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">750</td><td headers="hd_h_ch15.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></p>
|
|
<p>due to risk of bias, imprecision, inconsistency</p>
|
|
</td><td headers="hd_h_ch15.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">82 (59 to 96)</td><td headers="hd_h_ch15.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71 (48 to 87)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">The assessment of the evidence quality was conducted with emphasis on sensitivity as this was identified by the committee as the primary measure in guiding decision-making.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="ch15.tab3_1"><p class="no_margin">Risk of bias was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment if the majority of studies were rated at high risk of bias, and downgraded by 2 increments if the majority of studies were rated at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="ch15.tab3_2"><p class="no_margin">Inconsistency was assessed by inspection of the sensitivity and specificity plots. Particular attention was placed on the sensitivity threshold set by the committee as an acceptable level to recommend a test. The evidence was
|
|
<ul id="ch15.l1"><li id="ch15.lt1" class="half_rhythm"><div>downgraded by 1 increment if the individual study values varied across 2 areas: where values of individual studies are both above and below 50%, or both above and below the acceptable threshold 90%</div></li><li id="ch15.lt2" class="half_rhythm"><div>downgraded by 2 increments if the individual study values varied across 3 areas, where values of individual studies are above and below 50%, and also above and below the acceptable threshold 90%</div></li></ul></p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="ch15.tab3_3"><p class="no_margin">Imprecision was assessed based on inspection of the confidence region of sensitivity in the diagnostic meta-analysis</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch15tab4"><div id="ch15.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: UGFNAC vs PGFNAC, inadequate sample</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch15.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch15.tab4_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch15.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch15.tab4_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch15.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch15.tab4_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch15.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch15.tab4_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_ch15.tab4_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_ch15.tab4_1_1_1_5" id="hd_h_ch15.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with PGFNAC</th><th headers="hd_h_ch15.tab4_1_1_1_5" id="hd_h_ch15.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with UGFNAC (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch15.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inadequate sample</td><td headers="hd_h_ch15.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>750</p>
|
|
<p>(5 studies)</p>
|
|
</td><td headers="hd_h_ch15.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>1</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch15.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.56 (0.44 to 0.72)</td><td headers="hd_h_ch15.tab4_1_1_1_5 hd_h_ch15.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">172 per 1000</td><td headers="hd_h_ch15.tab4_1_1_1_5 hd_h_ch15.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">76 fewer per 1000 (from 96 fewer to 48 more)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch15.tab4_1"><p class="no_margin">Downgraded by 1 or 2 increments because the majority of the evidence was at high risk of bias or very high risk of bias</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch15tab5"><div id="ch15.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Health economic evidence profile: Palpation-guided fine-needle aspiration cytology (PGFNAC) versus Ultrasound-guided fine-needle aspiration cytology (UGFNAC)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch15.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_ch15.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Applicability</th><th id="hd_h_ch15.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Limitations</th><th id="hd_h_ch15.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Other comments</th><th id="hd_h_ch15.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental cost</th><th id="hd_h_ch15.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental effects</th><th id="hd_h_ch15.tab5_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost effectiveness</th><th id="hd_h_ch15.tab5_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Uncertainty</th></tr></thead><tbody><tr><td headers="hd_h_ch15.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Cesur 2006<a class="bibr" href="#ch15.ref4" rid="ch15.ref4"><sup>4</sup></a><sup>,</sup>
|
|
<sup>114</sup><sup>,</sup>
|
|
<sup>114</sup><sup>,</sup>
|
|
<a class="bibr" href="#ch15.ref11" rid="ch15.ref11"><sup>11</sup></a></p>
|
|
<p>(Turkey)</p>
|
|
</td><td headers="hd_h_ch15.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially applicable<sup>(a)</sup></td><td headers="hd_h_ch15.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Potentially serious limitations<sup>(b)</sup></td><td headers="hd_h_ch15.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic cohort study</td><td headers="hd_h_ch15.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">+£13<sup>(c)</sup></td><td headers="hd_h_ch15.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">+0.009 extra cancers detected<sup>(d)</sup></td><td headers="hd_h_ch15.tab5_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1,361 per extra cancer detected</td><td headers="hd_h_ch15.tab5_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No sensitivity analysis was conducted.</td></tr><tr><td headers="hd_h_ch15.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>National Guideline Centre – original guideline model</p>
|
|
<p>(UK)</p>
|
|
</td><td headers="hd_h_ch15.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially applicable<sup>(e)</sup></td><td headers="hd_h_ch15.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Minor limitations</td><td headers="hd_h_ch15.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Decision tree model</td><td headers="hd_h_ch15.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>With repeat test</u>
|
|
<sup>
|
|
(f)
|
|
</sup>
|
|
<u>:</u>
|
|
</p>
|
|
<p>-£21.00</p>
|
|
<p>
|
|
<u>Without repeat test</u>
|
|
</p>
|
|
<p>-£58.00</p>
|
|
</td><td headers="hd_h_ch15.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>With repeat test:</u>
|
|
</p>
|
|
<p>+0.016 cancers detected</p>
|
|
<p>
|
|
<u>Without repeat test</u>
|
|
</p>
|
|
<p>+0.006 cancers detected</p>
|
|
</td><td headers="hd_h_ch15.tab5_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>With repeat test:</u>
|
|
</p>
|
|
<p>UGFNAC dominant</p>
|
|
<p>
|
|
<u>Without repeat test</u>
|
|
</p>
|
|
<p>UGFNAC dominant</p>
|
|
</td><td headers="hd_h_ch15.tab5_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Various one-way sensitivity analyses</p>
|
|
<p>
|
|
<u>With repeat test:</u>
|
|
</p>
|
|
<p>UGFNAC dominant except when the price of UGFNAC was increased by 50% - £5,203 per cancer or surgery cost high- £183 per cancer detected</p>
|
|
<p>
|
|
<u>Without repeat test:</u>
|
|
</p>
|
|
<p>UGFNAC dominant except when the price of UGFNAC was increased by 50% - £15,162 per cancer</p>
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</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="ch15.tab5_1"><p class="no_margin">Turkish health service perspective; outcomes were not valued using QALYs.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="ch15.tab5_2"><p class="no_margin">Data taken from single study of 215 patients; currency and cost year not stated, costs taken from Turkish hospitals (private and state hospitals); no sensitivity analysis undertaken.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="ch15.tab5_3"><p class="no_margin">2006 US Dollars, presented as UK pound. US dollars converted using 2006 purchasing power parities <a class="bibr" href="#ch15.ref40" rid="ch15.ref40"><sup>40</sup></a>. Costs incorporated are: prices of thyroid ultrasonography, PGFNAC, UGFNAC and cytologic examinations.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(d)</dt><dd><div id="ch15.tab5_4"><p class="no_margin">Two extra cancers detected in the whole population</p></div></dd></dl><dl class="bkr_refwrap"><dt>(e)</dt><dd><div id="ch15.tab5_5"><p class="no_margin">Quality-adjusted life-years were not calculated and only costs for the diagnostic pathway were used.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(f)</dt><dd><div id="ch15.tab5_6"><p class="no_margin">Test repeated after an initial benign test result.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch15tab6"><div id="ch15.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Summary of the base case model inputs used in the model</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Parameter description</th><th id="hd_h_ch15.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Point estimate</th><th id="hd_h_ch15.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Source</th><th id="hd_h_ch15.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Distribution</th></tr></thead><tbody><tr><th headers="hd_h_ch15.tab6_1_1_1_1 hd_h_ch15.tab6_1_1_1_2 hd_h_ch15.tab6_1_1_1_3 hd_h_ch15.tab6_1_1_1_4" id="hd_b_ch15.tab6_1_1_1_1" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">Diagnosis parameters</th></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prevalence of cancer among patients with a normally functioning but enlarged thyroid</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.05</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Borget, et al 2018<a class="bibr" href="#ch15.ref1" rid="ch15.ref1"><sup>1</sup></a></td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Beta</td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Positive predictive value (PPV) of US</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.115</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Calculation</td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Function of the prevalence of cancer above and the Sensitivity and Specificity of ultrasound</td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity of US</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.904</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Persichetti 2018 <a class="bibr" href="#ch15.ref7" rid="ch15.ref7"><sup>7</sup></a></td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Function of the prevalence and DOR of US</td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity of US</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.634</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Persichetti 2018 <a class="bibr" href="#ch15.ref7" rid="ch15.ref7"><sup>7</sup></a></td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Beta</td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic odds ratio (DOR) of US</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.295</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Function of sensitivity and specificity</td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Log Normal</td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity of UGFNAC</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.900</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pooled estimate</td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sampled from the joint distribution from WinBUGS</td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity of UGFNAC</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.865</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pooled estimate</td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sampled from the joint distribution from WinBUGS</td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity of PGFNAC</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.71</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pooled estimate</td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sampled from the joint distribution from WinBUGS</td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity of PGFNAC</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.82</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pooled estimate</td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sampled from the joint distribution from WinBUGS</td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><th headers="hd_h_ch15.tab6_1_1_1_1 hd_h_ch15.tab6_1_1_1_2 hd_h_ch15.tab6_1_1_1_3 hd_h_ch15.tab6_1_1_1_4" id="hd_b_ch15.tab6_1_1_13_1" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">Cost (£)</th></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">UGFNAC</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£295</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Committee member</td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gamma</td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PGFNAC</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£242</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Committee member</td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gamma</td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgery</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3,689</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2016/17</td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gamma</td></tr><tr><td headers="hd_h_ch15.tab6_1_1_1_1 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FN cost (delayed diagnosis)</td><td headers="hd_h_ch15.tab6_1_1_1_2 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£4,197</td><td headers="hd_h_ch15.tab6_1_1_1_3 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2016/17</td><td headers="hd_h_ch15.tab6_1_1_1_4 hd_b_ch15.tab6_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gamma</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin"><i>Abbreviations: US: ultrasound; UGFNAC</i>: Ultrasound guided fine-needle aspiration cytology; PGFNAC: Palpation guided fine-needle aspiration cytology; FN: false negatives</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch15tab7"><div id="ch15.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Base case analysis results per 1000 patients in order of cost (probabilistic analysis)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.tab7_lrgtbl__"><table><thead><tr><th id="hd_h_ch15.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Strategy</th><th id="hd_h_ch15.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">Costs</th><th id="hd_h_ch15.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">Cancers detected (True Positives)</th><th id="hd_h_ch15.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">Additional Cost (compared with row above)</th><th id="hd_h_ch15.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">Additional cancers detected (compared with row above)</th><th id="hd_h_ch15.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">Additional cost per extra cancer detected</th></tr></thead><tbody><tr><td headers="hd_h_ch15.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">UGFNAC without benign repeat</td><td headers="hd_h_ch15.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£858,932</td><td headers="hd_h_ch15.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">105</td><td headers="hd_h_ch15.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">-</td><td headers="hd_h_ch15.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">-</td><td headers="hd_h_ch15.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">-</td></tr><tr><td headers="hd_h_ch15.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">PGFNAC without benign repeat</td><td headers="hd_h_ch15.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£879,936</td><td headers="hd_h_ch15.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">90</td><td headers="hd_h_ch15.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£21,004</td><td headers="hd_h_ch15.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">-15.7</td><td headers="hd_h_ch15.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">Dominated</td></tr><tr><td headers="hd_h_ch15.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">UGFNAC with benign repeat</td><td headers="hd_h_ch15.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1,451,488</td><td headers="hd_h_ch15.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">113</td><td headers="hd_h_ch15.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£571,551</td><td headers="hd_h_ch15.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">23.7</td><td headers="hd_h_ch15.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£74,263 (vs UGFNAC without benign repeat)</td></tr><tr><td headers="hd_h_ch15.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">PGFNAC with benign repeat</td><td headers="hd_h_ch15.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1,509,489</td><td headers="hd_h_ch15.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">107</td><td headers="hd_h_ch15.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£58,002</td><td headers="hd_h_ch15.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">-6.2</td><td headers="hd_h_ch15.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">Dominated</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobch15fig1"><div id="ch15.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Base%20case%20cost-effectiveness%20plane%20showing%20the%20different%20diagnostic%20strategies%20(probabilistic).&p=BOOKS&id=577221_ch15f1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577221/bin/ch15f1.jpg" alt="Figure 1. Base case cost-effectiveness plane showing the different diagnostic strategies (probabilistic)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Base case cost-effectiveness plane showing the different diagnostic strategies (probabilistic)</span></h3></div></article><article data-type="table-wrap" id="figobch15appatab1"><div id="ch15.appa.tab1" class="table"><h3><span class="label">Table 8</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.appa.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.appa.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ID</th><th id="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Field</th><th id="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Content</th></tr></thead><tbody><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">I</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Should a fine-needle aspiration biopsy (FNAB) be under ultrasound guidance?</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">II</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type of review question</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Diagnostic</p>
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<p>A review of health economic evidence related to the same review question was conducted in parallel with this review. For details see the health economic review protocol for this NICE guideline.</p>
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</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">III</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Objective of the review</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To determine the accuracy of FNAB with and without ultrasound</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IV</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – population / disease / condition / issue / domain</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch15.l10"><li id="ch15.lt33" class="half_rhythm"><div>People presenting with euthyroid thyroid enlargement with preliminary investigation suggesting need for biopsy</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">V</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – intervention(s) / exposure(s) / prognostic factor(s)</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch15.l11"><li id="ch15.lt34" class="half_rhythm"><div>FNAB without ultrasound</div></li><li id="ch15.lt35" class="half_rhythm"><div>FNAB with ultrasound</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VI</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – comparator(s) / control or reference (gold) standard</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch15.l12"><li id="ch15.lt36" class="half_rhythm"><div>Reference standard will be malignant status as confirmed by core biopsy or surgery/subsequent development of cancer in case of false negatives that are not further investigated</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VII</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes and prioritisation</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch15.l13"><li id="ch15.lt37" class="half_rhythm"><div>Sensitivity, specificity, PPV, NPV of tests for diagnosing thyroid cancer</div></li></ul>
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Sensitivity will be prioritised for decision making</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VIII</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – study design</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch15.l14"><li id="ch15.lt38" class="half_rhythm"><div>Diagnostic accuracy studies</div></li><li id="ch15.lt39" class="half_rhythm"><div>Prospective studies prioritised, retrospective studies included if insufficient prospective studies identified</div></li><li id="ch15.lt40" class="half_rhythm"><div>Evidence will be extracted according to the following hierarchy, lower levels will only be considered if insufficient evidence for decision making is found for higher levels:
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<ul id="ch15.l15" class="circle"><li id="ch15.lt41" class="half_rhythm"><div>Studies in which entire population gets FNAB without ultrasound and with ultrasound</div></li><li id="ch15.lt42" class="half_rhythm"><div>Studies in which FNAB with ultrasound and without ultrasound are compared in the same setting</div></li><li id="ch15.lt43" class="half_rhythm"><div>Studies in which only one of FNAB with ultrasound or without ultrasound is assessed</div></li></ul></div></li></ul>
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</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IX</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other inclusion exclusion criteria</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch15.l16"><li id="ch15.lt44" class="half_rhythm"><div>Excluding two gate study design</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">X</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Proposed sensitivity / subgroup analysis, or metaregression</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None specified</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XI</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Selection process – duplicate screening / selection / analysis</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A sample of at least 10% of the abstract lists were double-sifted by a senior research fellow and discrepancies rectified, with committee input where consensus could not be reached, for more information please see the separate Methods report for this guideline.</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XII</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data management (software)</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch15.l17"><li id="ch15.lt45" class="half_rhythm"><div>Endnote was used for bibliography, citations, sifting and reference management</div></li><li id="ch15.lt46" class="half_rhythm"><div>Pairwise meta-analyses were performed using Cochrane Review Manager (RevMan5).</div></li><li id="ch15.lt47" class="half_rhythm"><div>GRADEpro was used to assess the quality of evidence for each outcome.</div></li><li id="ch15.lt48" class="half_rhythm"><div>WinBUGS was used for meta-analysis of accuracy outcomes</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XIII</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Information sources – databases and dates</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<ul id="ch15.l18"><li id="ch15.lt49" class="half_rhythm"><div>Medline, Embase and the Cochrane library</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XIV</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Identify if an update</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not an update</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XV</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Author contacts</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://www.nice.org.uk/guidance/indevelopment/gid-ng10074" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org<wbr style="display:inline-block"></wbr>​.uk/guidance/indevelopment/gid-ng10074</a>
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</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XVI</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Highlight if amendment to previous protocol</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not an amendment</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XVII</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search strategy – for one database</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see <a href="#ch15.appb">appendix B</a></td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XVIII</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data collection process – forms / duplicate</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A standardised evidence table format will be used, and published as <a href="#ch15.appd">appendix D</a> of the evidence report.</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XIX</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data items – define all variables to be collected</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see evidence tables in <a href="#ch15.appd">Appendix D</a> (clinical evidence tables) or <a href="#ch15.appg">G</a> (health economic evidence tables).</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XX</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for assessing bias at outcome / study level</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>QUADAS-2 checklists were used to critically appraise individual studies. For details please see section 6.2 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a></p>
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<p>The risk of bias across all available evidence was evaluated for each outcome using an adaptation of the ‘Grading of Recommendations</p>
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<p>Assessment, Development and Evaluation (GRADE) toolbox’ developed by the international GRADE working group <a href="http://www.gradeworkinggroup.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.gradeworkinggroup.org/</a></p>
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</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXI</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Criteria for quantitative synthesis</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.4 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXII</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for quantitative analysis – combining studies and exploring (in)consistency</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the separate Methods report for this guideline.</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXIII</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-bias assessment – publication bias, selective reporting bias</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.2 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXIV</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confidence in cumulative evidence</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see sections 6.4 and 9.1 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1-Introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXV</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rationale / context – what is known</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the introduction to the evidence review.</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXVI</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Describe contributions of authors and guarantor</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>A <a href="https://www.nice.org.uk/guidance/ng145/documents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">multidisciplinary committee</a> developed the evidence review. The committee was convened by the National Guideline Centre (NGC) and chaired by Sarah Fishburn line with section 3 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1%20Introduction%20and%20overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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<p>Staff from NGC undertook systematic literature searches, appraised the evidence, conducted meta-analysis and cost-effectiveness analysis where appropriate, and drafted the evidence review in collaboration with the committee. For details please see <a href="https://www.nice.org.uk/article/pmg20/chapter/1-Introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXVII</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sources of funding / support</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NGC is funded by NICE and hosted by the Royal College of Physicians.</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXVIII</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Name of sponsor</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NGC is funded by NICE and hosted by the Royal College of Physicians.</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXIX</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roles of sponsor</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NICE funds NGC to develop guidelines for those working in the NHS, public health and social care in England.</td></tr><tr><td headers="hd_h_ch15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXX</td><td headers="hd_h_ch15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PROSPERO registration number</td><td headers="hd_h_ch15.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not registered</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch15appatab2"><div id="ch15.appa.tab2" class="table"><h3><span class="label">Table 9</span><span class="title">Health economic review protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.appa.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.appa.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch15.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Review question</th><th id="hd_h_ch15.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">All questions – health economic evidence</th></tr></thead><tbody><tr><td headers="hd_h_ch15.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Objectives</b>
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</td><td headers="hd_h_ch15.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To identify health economic studies relevant to any of the review questions.</td></tr><tr><td headers="hd_h_ch15.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Search criteria</b>
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</td><td headers="hd_h_ch15.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch15.l19"><li id="ch15.lt50" class="half_rhythm"><div>Populations, interventions and comparators must be as specified in the clinical review protocol above.</div></li><li id="ch15.lt51" class="half_rhythm"><div>Studies must be of a relevant health economic study design (cost–utility analysis, cost-effectiveness analysis, cost–benefit analysis, cost–consequences analysis, comparative cost analysis).</div></li><li id="ch15.lt52" class="half_rhythm"><div>Studies must not be a letter, editorial or commentary, or a review of health economic evaluations. (Recent reviews will be ordered although not reviewed. The bibliographies will be checked for relevant studies, which will then be ordered.)</div></li><li id="ch15.lt53" class="half_rhythm"><div>Unpublished reports will not be considered unless submitted as part of a call for evidence.</div></li><li id="ch15.lt54" class="half_rhythm"><div>Studies must be in English.</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch15.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Search strategy</b>
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</td><td headers="hd_h_ch15.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A health economic study search will be undertaken using population-specific terms and a health economic study filter – see <a href="#ch15.appb">Appendix B</a>: below.</td></tr><tr><td headers="hd_h_ch15.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Review strategy</b>
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</td><td headers="hd_h_ch15.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Studies not meeting any of the search criteria above will be excluded. Studies published before 2003, abstract-only studies and studies from non-OECD countries or the USA will also be excluded.</p><p>Each remaining study will be assessed for applicability and methodological limitations using the NICE economic evaluation checklist which can be found in <a href="#ch15.apph">appendix H</a> of Developing NICE guidelines: the manual (2014).<a class="bibr" href="#ch15.ref37" rid="ch15.ref37"><sup>37</sup></a></p><p><b>Inclusion and exclusion criteria</b>
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<ul id="ch15.l20"><li id="ch15.lt55" class="half_rhythm"><div>If a study is rated as both ‘Directly applicable’ and with ‘Minor limitations’ then it will be included in the guideline. A health economic evidence table will be completed and it will be included in the health economic evidence profile.</div></li><li id="ch15.lt56" class="half_rhythm"><div>If a study is rated as either ‘Not applicable’ or with ‘Very serious limitations’ then it will usually be excluded from the guideline. If it is excluded then a health economic evidence table will not be completed and it will not be included in the health economic evidence profile.</div></li><li id="ch15.lt57" class="half_rhythm"><div>If a study is rated as ‘Partially applicable’, with ‘Potentially serious limitations’ or both then there is discretion over whether it should be included.</div></li></ul></p>
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<p><b>Where there is discretion</b></p><p>The health economist will make a decision based on the relative applicability and quality of the available evidence for that question, in discussion with the guideline committee if required. The ultimate aim is to include health economic studies that are helpful for decision-making in the context of the guideline and the current NHS setting. If several studies are considered of sufficiently high applicability and methodological quality that they could all be included, then the health economist, in discussion with the committee if required, may decide to include only the most applicable studies and to selectively exclude the remaining studies. All studies excluded on the basis of applicability or methodological limitations will be listed with explanation in the excluded health economic studies appendix below.</p><p>The health economist will be guided by the following hierarchies.</p><p><i>Setting:</i>
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<ul id="ch15.l21"><li id="ch15.lt58" class="half_rhythm"><div>UK NHS (most applicable).</div></li><li id="ch15.lt59" class="half_rhythm"><div>OECD countries with predominantly public health insurance systems (for example, France, Germany, Sweden).</div></li><li id="ch15.lt60" class="half_rhythm"><div>OECD countries with predominantly private health insurance systems (for example, Switzerland).</div></li><li id="ch15.lt61" class="half_rhythm"><div>Studies set in non-OECD countries or in the USA will be excluded before being assessed for applicability and methodological limitations.</div></li></ul></p>
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<p><i>Health economic study type:</i>
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<ul id="ch15.l22"><li id="ch15.lt62" class="half_rhythm"><div>Cost–utility analysis (most applicable).</div></li><li id="ch15.lt63" class="half_rhythm"><div>Other type of full economic evaluation (cost–benefit analysis, cost-effectiveness analysis, cost–consequences analysis).</div></li><li id="ch15.lt64" class="half_rhythm"><div>Comparative cost analysis.</div></li><li id="ch15.lt65" class="half_rhythm"><div>Non-comparative cost analyses including cost-of-illness studies will be excluded before being assessed for applicability and methodological limitations.</div></li></ul></p>
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<p><i>Year of analysis:</i>
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<ul id="ch15.l23"><li id="ch15.lt66" class="half_rhythm"><div>The more recent the study, the more applicable it will be.</div></li><li id="ch15.lt67" class="half_rhythm"><div>Studies published in 2003 or later but that depend on unit costs and resource data entirely or predominantly from before 2003 will be rated as ‘Not applicable’.</div></li><li id="ch15.lt68" class="half_rhythm"><div>Studies published before 2003 will be excluded before being assessed for applicability and methodological limitations.</div></li></ul></p>
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<p><i>Quality and relevance of effectiveness data used in the health economic analysis:</i>
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<ul id="ch15.l24"><li id="ch15.lt69" class="half_rhythm"><div>The more closely the clinical effectiveness data used in the health economic analysis match with the outcomes of the studies included in the clinical review the more useful the analysis will be for decision-making in the guideline.</div></li></ul></p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch15appbtab1"><div id="ch15.appb.tab1" class="table"><h3><span class="label">Table 10</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch15.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_ch15.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_ch15.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ch15.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline (OVID)</td><td headers="hd_h_ch15.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1946 – 07 January 2019</td><td headers="hd_h_ch15.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions</p>
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<p>Randomised controlled trials</p>
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<p>Observational studies</p>
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<p>Diagnostic tests studies</p>
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</td></tr><tr><td headers="hd_h_ch15.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase (OVID)</td><td headers="hd_h_ch15.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1974 – 07 January 2019</td><td headers="hd_h_ch15.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions</p>
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<p>Randomised controlled trials</p>
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<p>Observational studies</p>
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<p>Diagnostic tests studies</p>
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</td></tr><tr><td headers="hd_h_ch15.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Cochrane Library (Wiley)</td><td headers="hd_h_ch15.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Cochrane Reviews to 2019 Issue 1 or 12</p>
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<p>CENTRAL to 2019 Issue 1 or 12</p>
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<p>DARE, and NHSEED to 2015 Issue 2 of 4</p>
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<p>HTA to 2016 Issue 2 of 4</p>
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</td><td headers="hd_h_ch15.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch15appbtab2"><div id="ch15.appb.tab2" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.appb.tab2_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp thyroid diseases/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hyperthyroid*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hypothyroid*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">thyrotoxicosis.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(thyroid adj3 (swell* or dysfunction* or enlarg* or nodule* or node* or disease* or condition* or disorder*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-5</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/7-14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 not 16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17-23</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 not 24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Biopsy, Fine-Needle/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(FNA or FNAB or FNA biops* or fine needle aspiration or fine needle aspiration biops* or fine-needle aspiration or fine-needle aspiration biops* or (palpation guid* adj3 aspiration)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 or 27</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25 and 28</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">controlled clinical trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomi#ed.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomly.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clinical Trials as topic.sh.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">trial.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/30-36</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “sensitivity and specificity”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sensitivity or specificity).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((pre test or pretest or post test) adj probability).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(predictive value* or PPV or NPV).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">likelihood ratio*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">likelihood function/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((area under adj4 curve) or AUC).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(receive* operat* characteristic* or receive* operat* curve* or ROC curve*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(diagnos* adj3 (performance* or accurac* or utilit* or value* or efficien* or effectiveness)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">gold standard.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/38-47</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Epidemiologic studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Cohort studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cohort adj (study or studies or analys* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((follow up or observational or uncontrolled or non randomi#ed or epidemiologic*) adj (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((longitudinal or retrospective or prospective or cross sectional) and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Controlled Before-After Studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Historically Controlled Study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interrupted Time Series Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(before adj2 after adj2 (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/49-58</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp case control study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case control*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/60-61</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59 or 62</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cross-sectional studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cross sectional and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/64-65</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59 or 66</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59 or 62 or 66</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29 and (37 or 48 or 68)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 69 to English language</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch15appbtab3"><div id="ch15.appb.tab3" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.appb.tab3_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp thyroid diseases/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hyperthyroid*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hypothyroid*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">thyrotoxicosis.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(thyroid adj3 (swell* or dysfunction* or enlarg* or nodule* or node* or disease* or condition* or disorder*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-5</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/7-11</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 not 13</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/14-21</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 not 22</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">fine needle aspiration biopsy/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(FNA or FNAB or FNA biops* or fine needle aspiration or fine needle aspiration biops* or fine-needle aspiration or fine-needle aspiration biops* or (palpation guid* adj3 aspiration)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 or 25</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23 and 26</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">factorial*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(crossover* or cross over*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((doubl* or singl*) adj blind*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(assign* or allocat* or volunteer* or placebo*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">crossover procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">single blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">double blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/28-36</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “sensitivity and specificity”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sensitivity or specificity).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((pre test or pretest or post test) adj probability).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(predictive value* or PPV or NPV).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">likelihood ratio*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((area under adj4 curve) or AUC).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(receive* operat* characteristic* or receive* operat* curve* or ROC curve*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(diagnos* adj3 (performance* or accurac* or utilit* or value* or efficien* or effectiveness)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">diagnostic accuracy/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">diagnostic test accuracy study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">gold standard.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/38-48</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clinical study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">family study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">longitudinal study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">retrospective study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">prospective study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cohort analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">follow-up/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cohort*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57 and 58</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cohort adj (study or studies or analys* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((follow up or observational or uncontrolled or non randomi#ed or epidemiologic*) adj (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((longitudinal or retrospective or prospective or cross sectional) and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(before adj2 after adj2 (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/50-56,59-63</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp case control study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case control*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/65-66</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64 or 67</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cross-sectional study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cross sectional and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/69-70</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64 or 71</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64 or 67 or 71</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">74.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27 and (37 or 49 or 73)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">75.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 74 to English language</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch15appbtab4"><div id="ch15.appb.tab4" class="table"><h3><span class="title">Cochrane Library (Wiley) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.appb.tab4_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Thyroid Diseases] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hyperthyroid*:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hypothyroid*:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">thyrotoxicosis:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(thyroid near/3 (swell* or dysfunction* or enlarg* or nodule* or node* or disease* or condition* or disorder*)) ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #1-#5)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Biopsy, Fine-Needle] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(FNA or FNAB or FNA biops* or fine needle aspiration or fine needle aspiration biops* or fine-needle aspiration or fine-needle aspiration biops* or (palpation guid* near/3 aspiration)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7 or #8</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6 and #9</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch15appbtab5"><div id="ch15.appb.tab5" class="table"><h3><span class="label">Table 11</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.appb.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_ch15.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_ch15.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_ch15.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ch15.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline</td><td headers="hd_h_ch15.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 07 January 2019</td><td headers="hd_h_ch15.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health economics studies</p>
|
|
<p>Health economics modelling studies</p>
|
|
<p>Quality of life studies</p>
|
|
</td></tr><tr><td headers="hd_h_ch15.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase</td><td headers="hd_h_ch15.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 07 January 2019</td><td headers="hd_h_ch15.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health economics studies</p>
|
|
<p>Health economics modelling studies</p>
|
|
<p>Quality of life studies</p>
|
|
</td></tr><tr><td headers="hd_h_ch15.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Centre for Research and Dissemination (CRD)</td><td headers="hd_h_ch15.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HTA - Inception – 07 January 2019</p>
|
|
<p>NHSEED - Inception to March 2015</p>
|
|
</td><td headers="hd_h_ch15.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch15appbtab6"><div id="ch15.appb.tab6" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.appb.tab6_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp thyroid diseases/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hyperthyroid*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hypothyroid*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">thyrotoxicosis.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(thyroid adj3 (swell* or dysfunction* or enlarg* or nodule* or node* or disease* or condition* or disorder*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-5</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/7-14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 not 16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17-23</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 not 24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 25 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of life/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Costs and Cost Analysis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Hospital/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Medical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Pharmaceutical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and Charges”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Budgets/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/27-42</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp models, economic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Models, Theoretical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Models, Organizational/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">markov chains/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">monte carlo method/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Decision Theory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(markov* or monte carlo).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">econom* model*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decision* adj2 (tree* or analy* or model*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/44-52</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">quality-adjusted life years/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">sickness impact profile/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(quality adj2 (wellbeing or well being)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">sickness impact profile.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">disability adjusted life.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(qal* or qtime* or qwb* or daly*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(euroqol* or eq5d* or eq 5*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(qol* or hql* or hqol* or h qol* or hrqol* or hr qol*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(health utility* or utility score* or disutilit* or utility value*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hui or hui1 or hui2 or hui3).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(health* year* equivalent* or hye or hyes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">discrete choice*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">rosser.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(willingness to pay or time tradeoff or time trade off or tto or standard gamble*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf36* or sf 36* or short form 36* or shortform 36* or shortform36*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf20 or sf 20 or short form 20 or shortform 20 or shortform20).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf12* or sf 12* or short form 12* or shortform 12* or shortform12*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf8* or sf 8* or short form 8* or shortform 8* or shortform8*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf6* or sf 6* or short form 6* or shortform 6* or shortform6*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/54-72</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">74.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 and (43 or 53 or 73)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch15appbtab7"><div id="ch15.appb.tab7" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.appb.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.appb.tab7_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp thyroid diseases/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hyperthyroid*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hypothyroid*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">thyrotoxicosis*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(thyroid adj3 (swell* or dysfunction* or enlarg* or nodule* or node* or disease* or condition* or disorder*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-5</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/7-11</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 not 13</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/14-21</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 not 22</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 23 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">health economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp economic evaluation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp health care cost/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp fee/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">funding/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/25-37</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">statistical model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp economic aspect/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39 and 40</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*theoretical model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*nonbiological model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">stochastic model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">decision theory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">decision tree/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">monte carlo method/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(markov* or monte carlo).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">econom* model*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decision* adj2 (tree* or analy* or model*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/41-50</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">quality adjusted life year/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“quality of life index”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">short form 12/ or short form 20/ or short form 36/ or short form 8/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">sickness impact profile/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(quality adj2 (wellbeing or well being)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">sickness impact profile.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">disability adjusted life.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(qal* or qtime* or qwb* or daly*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(euroqol* or eq5d* or eq 5*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(qol* or hql* or hqol* or h qol* or hrqol* or hr qol*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(health utility* or utility score* or disutilit* or utility value*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hui or hui1 or hui2 or hui3).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(health* year* equivalent* or hye or hyes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">discrete choice*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">rosser.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(willingness to pay or time tradeoff or time trade off or tto or standard gamble*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf36* or sf 36* or short form 36* or shortform 36* or shortform36*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf20 or sf 20 or short form 20 or shortform 20 or shortform20).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf12* or sf 12* or short form 12* or shortform 12* or shortform12*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf8* or sf 8* or short form 8* or shortform 8* or shortform8*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf6* or sf 6* or short form 6* or shortform 6* or shortform6*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/52-72</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">74.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 and (38 or 51 or 73)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch15appbtab8"><div id="ch15.appb.tab8" class="table"><h3><span class="title">NHS EED and HTA (CRD) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.appb.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.appb.tab8_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">MeSH DESCRIPTOR Thyroid Diseases EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">hyperthyroid*</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">hypothyroid*</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">thyrotoxicosis*</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">(thyroid adj3 (swell* or dysfunction* or enlarg* or nodule* or node* or disease* or condition* or disorder*))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">#1 OR #2 OR #3 OR #4 or #5</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobch15appcfig1"><div id="ch15.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Flow%20chart%20of%20clinical%20study%20selection%20for%20the%20review%20of%20FNAB%20with%20or%20without%20ultrasound.&p=BOOKS&id=577221_ch15appcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577221/bin/ch15appcf1.jpg" alt="Figure 2. Flow chart of clinical study selection for the review of FNAB with or without ultrasound." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Flow chart of clinical study selection for the review of FNAB with or without ultrasound</span></h3></div></article><article data-type="fig" id="figobch15appefig1"><div id="ch15.appe.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%203.%20UGFNAC.&p=BOOKS&id=577221_ch15appef1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577221/bin/ch15appef1.jpg" alt="Figure 3. UGFNAC." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 3</span><span class="title">UGFNAC</span></h3></div></article><article data-type="fig" id="figobch15appefig2"><div id="ch15.appe.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%204.%20PGFNAC.&p=BOOKS&id=577221_ch15appef2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577221/bin/ch15appef2.jpg" alt="Figure 4. PGFNAC." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 4</span><span class="title">PGFNAC</span></h3></div></article><article data-type="fig" id="figobch15appefig3"><div id="ch15.appe.fig3" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%205.%20Inadequate%20results.&p=BOOKS&id=577221_ch15appef3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577221/bin/ch15appef3.jpg" alt="Figure 5. Inadequate results." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 5</span><span class="title">Inadequate results</span></h3></div></article><article data-type="fig" id="figobch15appffig1"><div id="ch15.appf.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%206.%20Flow%20chart%20of%20health%20economic%20study%20selection%20for%20the%20guideline.&p=BOOKS&id=577221_ch15appff1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577221/bin/ch15appff1.jpg" alt="Figure 6. Flow chart of health economic study selection for the guideline." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 6</span><span class="title">Flow chart of health economic study selection for the guideline</span></h3><div class="caption"><p>* Non-relevant population, intervention, comparison, design or setting; non-English language</p><p>TFT; thyroid function test, FNA; fine-needle aspiration, US; ultrasound, RAI; radioactive iodine, ATDs; antithyroid drugs, Mang; management, SCH; Subclinical hypothyroidism, SCT; Subclinical thyrotoxicosis.</p></div></div></article><article data-type="table-wrap" id="figobch15appitab1"><div id="ch15.appi.tab1" class="table"><h3><span class="label">Table 12</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.appi.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.appi.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference</th><th id="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusion reason</th></tr></thead><tbody><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Aksu 2014<a class="bibr" href="#ch15.ref1" rid="ch15.ref1"><sup>1</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: separate sample for each index test</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Al Maqbali 2012<a class="bibr" href="#ch15.ref2" rid="ch15.ref2"><sup>2</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: sample consisting of non-diagnostic first FNAC results; diagnostic accuracy calculated based on successive FNACs majority of which under US guidance</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bohacek 2012<a class="bibr" href="#ch15.ref3" rid="ch15.ref3"><sup>3</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Braga 2001<a class="bibr" href="#ch15.ref5" rid="ch15.ref5"><sup>5</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cai 2006<a class="bibr" href="#ch15.ref6" rid="ch15.ref6"><sup>6</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: separate sample for each index test</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cam 2014<a class="bibr" href="#ch15.ref7" rid="ch15.ref7"><sup>7</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison (Ultrasound vs CCT vs DW-MRI)</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Can 2008<a class="bibr" href="#ch15.ref9" rid="ch15.ref9"><sup>9</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: separate sample for each index test</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Can 2009<a class="bibr" href="#ch15.ref8" rid="ch15.ref8"><sup>8</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant outcomes</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Carmeci 1998<a class="bibr" href="#ch15.ref10" rid="ch15.ref10"><sup>10</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: separate sample for each index test</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Danese 1998<a class="bibr" href="#ch15.ref12" rid="ch15.ref12"><sup>12</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: separate sample for each index test</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">de Meer 2012<a class="bibr" href="#ch15.ref13" rid="ch15.ref13"><sup>13</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant outcomes</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Deandrea 2002<a class="bibr" href="#ch15.ref14" rid="ch15.ref14"><sup>14</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison (palpation vs FNA)</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Esfahanian 2016<a class="bibr" href="#ch15.ref15" rid="ch15.ref15"><sup>15</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hatada 1998<a class="bibr" href="#ch15.ref16" rid="ch15.ref16"><sup>16</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: separate sample for each index test</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Izquierdo 2006<a class="bibr" href="#ch15.ref17" rid="ch15.ref17"><sup>17</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: separate sample for each index test</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kawai 2012<a class="bibr" href="#ch15.ref19" rid="ch15.ref19"><sup>19</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison (Ultrasound vs FNA)</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kimoto 1999<a class="bibr" href="#ch15.ref20" rid="ch15.ref20"><sup>20</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lee 2013<a class="bibr" href="#ch15.ref23" rid="ch15.ref23"><sup>23</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lee 2009<a class="bibr" href="#ch15.ref24" rid="ch15.ref24"><sup>24</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: repeated UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lee 2013<a class="bibr" href="#ch15.ref22" rid="ch15.ref22"><sup>22</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Leung 2017<a class="bibr" href="#ch15.ref25" rid="ch15.ref25"><sup>25</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison (FNA before vs after biopsy centre implementation)</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lew 2010<a class="bibr" href="#ch15.ref26" rid="ch15.ref26"><sup>26</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-systematic review</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Li 2016<a class="bibr" href="#ch15.ref27" rid="ch15.ref27"><sup>27</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lin 1997<a class="bibr" href="#ch15.ref28" rid="ch15.ref28"><sup>28</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mehrotra 2006<a class="bibr" href="#ch15.ref29" rid="ch15.ref29"><sup>29</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: separate sample for each index test</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Melany 2017<a class="bibr" href="#ch15.ref30" rid="ch15.ref30"><sup>30</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-systematic review</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mirshemirani 2010<a class="bibr" href="#ch15.ref31" rid="ch15.ref31"><sup>31</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison (Ultrasound vs FNA)</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mittendorf 2002<a class="bibr" href="#ch15.ref32" rid="ch15.ref32"><sup>32</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: separate sample for each index test</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moon 2007<a class="bibr" href="#ch15.ref33" rid="ch15.ref33"><sup>33</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison (Ultrasound vs FNA)</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Muruganandham 2009<a class="bibr" href="#ch15.ref34" rid="ch15.ref34"><sup>34</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: separate sample for each index test</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nachiappan 2014<a class="bibr" href="#ch15.ref35" rid="ch15.ref35"><sup>35</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-systematic review</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nam-Goong 2004<a class="bibr" href="#ch15.ref36" rid="ch15.ref36"><sup>36</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Newkirk 2000<a class="bibr" href="#ch15.ref38" rid="ch15.ref38"><sup>38</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ogawa 2001<a class="bibr" href="#ch15.ref39" rid="ch15.ref39"><sup>39</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Peng 2007<a class="bibr" href="#ch15.ref41" rid="ch15.ref41"><sup>41</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rorive 2010<a class="bibr" href="#ch15.ref43" rid="ch15.ref43"><sup>43</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schwartz 2010<a class="bibr" href="#ch15.ref44" rid="ch15.ref44"><sup>44</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed (on sample with non-diagnostic PGFNAC)</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Singh Ospina 2016<a class="bibr" href="#ch15.ref45" rid="ch15.ref45"><sup>45</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">SR not matching PICO</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Witt 2015<a class="bibr" href="#ch15.ref47" rid="ch15.ref47"><sup>47</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: separate sample for each index test</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yang 2001<a class="bibr" href="#ch15.ref48" rid="ch15.ref48"><sup>48</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: UGFNAC only assessed</td></tr><tr><td headers="hd_h_ch15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Young 2011<a class="bibr" href="#ch15.ref49" rid="ch15.ref49"><sup>49</sup></a></td><td headers="hd_h_ch15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wrong study design: diagnostic results from UGFNAC only</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch15appitab2"><div id="ch15.appi.tab2" class="table"><h3><span class="label">Table 13</span><span class="title">Studies excluded from the health economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577221/table/ch15.appi.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch15.appi.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch15.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference</th><th id="hd_h_ch15.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_ch15.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Can 2009 <a class="bibr" href="#ch15.ref8" rid="ch15.ref8"><sup>8</sup></a></td><td headers="hd_h_ch15.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as not applicable, as the population did not match the clinical protocol and no relevant outcomes were recorded.</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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