Assessment of diagnostic capacity and decision-making based on the 2015 American Thyroid Association ultrasound classification system

Table 1 Risk of bias and applicability judgments

Ref.	Risk of bias			Flow and timing	Applicability
	Patient selection	Index test	Reference standard		Patient selection	Index test	Reference standard
Tang et al[25]	Low	Low	Low	Low	Low	Low	Low
Trimboli et al[28]	Low	Low	Low	Unclear	Low	Low	Low
Xu et al[29]	Low	Low	Low	Low	Low	Low	Low
Persichetti et al[30]	Low	Low	Low	Low	Low	Low	Low
Macedo et al[31]	Low	Low	Low	Low	Low	Low	Low
Chng et al[32]	Unclear	Unclear	Low	Low	High	Low	Low
Huang et al[34]	Low	Low	Low	Unclear	Low	Low	Low
Barbosa et al[35]	Unclear	Low	Low	Low	High	Low	Low
Hong et al[36]	Low	Low	Low	Low	Low	Low	Low
Valderrabano et al[37]	Low	Low	Low	Low	Low	Low	Low
Xiang et al[38]	Low	Low	Low	Low	Low	Low	Low
Gao et al[39]	Low	Low	Low	Low	Low	Low	Low
Shen et al[40]	Low	Low	Low	Low	Low	Low	Low

Table 2 Studies and number of patients included

Ref.	Very low		Low		Intermediate		High
	Cancer no	Cancer yes	Cancer no	Cancer yes	Cancer no	Cancer yes	Cancer no	Cancer yes
Tang et al[25]	7	1	20	5	17	7	0	8
Trimboli et al[28]	15	2	43	8	68	15	6	18
Xu et al[29]	36	2	190	21	212	59	109	277
Persichetti et al[30]	134	3	255	8	295	18	104	127
Macedo et al[31]	11	0	10	0	13	5	1	5
Chng et al[32]	16	1	60	10	18	12	13	27
Huang et al[34]	14	0	109	18	57	32	4	15
Barbosa et al[35]	4	1	33	10	27	9	10	46
Hong et al[36]	35	0	174	6	109	55	37	263
Valderrabano et al[37]	25	0	127	32	61	13	16	20
Xiang et al[38]	170	0	112	24	8	11	32	289
Gao et al[39]	178	0	339	20	107	55	233	1606
Shen et al[40]	187	6	149	17	348	42	150	708
Total	832	16	1621	179	1340	333	715	3409

Table 3 Pooled diagnostic value of ultrasound patterns studied

	Very Low	95%CI	Low	95%CI	Intermediate	95%CI	High	95%CI
Sensitivity	1%	0-1	5%	4-5	8%	8-9	87%	85-88
Specificity	82%	80-83	64%	63-65	70%	68-72	84%	83-85
Likelihood ratio (+)	0.07	0.03- 0.17	0.22	0.11-0.43	0.59	0.38-0.94	5.63	4.52-7.01