Thyroid nodules are common findings, particularly in iodine-deficient regions. Our paper aims to revise different diagnostic tools available in clinical thyroidology and propose their rational integration. We will elaborate on the pros and cons of thyroid ultrasound (US) and its scoring systems, thyroid scintigraphy, fine-needle aspiration cytology (FNAC), molecular imaging, and artificial intelligence (AI). Ultrasonographic scoring systems can help differentiate between benign and malignant nodules. Depending on the constellation or number of suspicious ultrasound features, a FNAC is recommended. However, hyperfunctioning thyroid nodules are presumed to exclude malignancy with a very high negative predictive value (NPV). Particularly in regions where iodine supply is low, most hyperfunctioning thyroid nodules are seen in patients with normal thyroid-stimulating hormone (TSH) levels. Thyroid scintigraphy is essential for the detection of these nodules. Among non-toxic thyroid nodules, a careful application of US risk stratification systems is pivotal to exclude inappropriate FNAC and guide the procedure on suspicious ones. However, almost one-third of cytology examinations are rendered as indeterminate, requiring “diagnostic surgery” to provide a definitive diagnosis.99mTc-methoxy-isobutyl-isonitrile ([99mTc]Tc-MIBI) and [18F]fluoro-deoxy-glucose ([18F]FDG) molecular imaging can spare those patients from unnecessary surgeries. The clinical value of AI in the evaluation of thyroid nodules needs to be determined.
甲状腺结节是常见的临床发现，在碘缺乏地区尤为普遍。本文旨在系统评述临床甲状腺学中现有的各类诊断工具，并提出其合理整合方案。我们将详细阐述甲状腺超声及其评分系统、甲状腺闪烁显像、细针穿刺细胞学检查、分子影像学以及人工智能等技术的优势与局限性。超声评分系统有助于鉴别结节良恶性，根据可疑超声特征的类型或数量可推荐进行细针穿刺细胞学检查。但高功能甲状腺结节通常被认为具有极高的阴性预测值，可基本排除恶性可能。尤其在碘供应不足地区，多数高功能结节患者的促甲状腺激素水平处于正常范围，此时甲状腺闪烁显像对这些结节的检测至关重要。对于非毒性甲状腺结节，合理应用超声风险分层系统对避免不必要穿刺、精准引导可疑结节活检具有关键意义。然而近三分之一的细胞学检查结果呈不确定性，需通过“诊断性手术”获得明确诊断。99mTc-甲氧基异丁基异腈与[18F]氟代脱氧葡萄糖分子影像技术可帮助此类患者避免不必要的手术。人工智能在甲状腺结节评估中的临床价值尚待进一步明确。
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