Background: The management of indeterminate thyroid nodules (Bethesda III/IV) has evolved with molecular testing, aiming to reduce unnecessary surgeries. However, the comparative effectiveness of different platforms in influencing surgical decision-making remains unclear. This systematic review and meta-analysis evaluate the impact of molecular testing on surgical avoidance rates.Methods: A systematic literature search was conducted across eight electronic databases, including Embase, PubMed, and Cochrane Library, from January 2019 to December 2024, following PRISMA guidelines to encompass most recent advancements in the last 5 years. Studies evaluating Afirma Gene Expression Classifier (GEC), Afirma Genomic Sequencing Classifier (GSC), ThyroSeq V2, ThyroSeq V3, and ThyGenX/ThyraMIR were included. The primary outcome was surgical avoidance, analyzed using a random-effects model.Results: Thirty-one studies comprising 4464 indeterminate thyroid nodules met inclusion criteria. Pooled surgical avoidance rates varied across platforms: ThyroSeq V2 (50.3%, 95% CI: 20.8–79.6%), ThyroSeq V3 (62.5%, 95% CI: 54.8–70.0%), Afirma GEC (58.8%, 95% CI: 43.6–73.1%), Afirma GSC (50.6%, 95% CI: 34.3–66.8%), and ThyGenX/ThyraMIR (68.6%, 95% CI: 63.1–73.9%). ThyGenX/ThyraMIR had the highest surgical avoidance rate and lowest heterogeneity (I2= 51.2%), while ThyroSeq showed improvement from V2 to V3.Conclusions: Molecular testing reduces unnecessary thyroid surgeries, with avoidance rates ranging from 50.3% to 68.6%. While ThyGenX/ThyraMIR showed the highest avoidance rate, its limited representation warrants cautious interpretation. Standardized protocols are needed to optimize clinical application. Further prospective studies should compare platforms and assess long-term outcomes and cost-effectiveness.
背景：随着分子检测技术的发展，不确定甲状腺结节（Bethesda III/IV类）的管理策略不断演进，旨在减少不必要的手术。然而，不同检测平台在影响手术决策方面的相对效果尚不明确。本系统综述与荟萃分析评估了分子检测对避免手术率的影响。 方法：遵循PRISMA指南，于2019年1月至2024年12月期间在Embase、PubMed、Cochrane图书馆等八个电子数据库中进行系统性文献检索，以涵盖近五年的最新进展。研究纳入评估Afirma基因表达分类器（GEC）、Afirma基因组测序分类器（GSC）、ThyroSeq V2、ThyroSeq V3以及ThyGenX/ThyraMIR平台的相关文献。主要结局指标为手术避免率，采用随机效应模型进行分析。 结果：共31项研究符合纳入标准，涵盖4464个不确定甲状腺结节。各平台的汇总手术避免率存在差异：ThyroSeq V2为50.3%（95% CI: 20.8–79.6%），ThyroSeq V3为62.5%（95% CI: 54.8–70.0%），Afirma GEC为58.8%（95% CI: 43.6–73.1%），Afirma GSC为50.6%（95% CI: 34.3–66.8%），ThyGenX/ThyraMIR为68.6%（95% CI: 63.1–73.9%）。其中ThyGenX/ThyraMIR平台的手术避免率最高且异质性最低（I²=51.2%），而ThyroSeq平台从V2到V3版本显示出性能提升。 结论：分子检测能有效减少不必要的甲状腺手术，手术避免率在50.3%至68.6%之间。虽然ThyGenX/ThyraMIR显示出最高的避免率，但其研究数量有限需谨慎解读。需要建立标准化方案以优化临床应用。未来需开展前瞻性研究比较不同平台，并评估长期结局与成本效益。
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