分化型甲状腺癌的诊疗进展  

Clinical and therapeutic perspectives on differentiated thyroid cancer

作　　者：王俊起[1] WANG Junqi(Department of Nuclear Medicine,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院核医学科

出　　处：《实用医学杂志》2019年第20期3258-3263,共6页The Journal of Practical Medicine

摘　　要：分化型甲状腺癌的发病率在全球范围内持续上升,新发现的甲状腺癌多数是低危险的乳头状癌,这与诊断技术的提高和广泛使用有关。但过去十年的证据也表明,晚期甲状腺癌的发病率和死亡率也在上升。分化型甲状腺癌的最佳治疗仍存在很多争议。目前,临床上主要挑战是避免对低危甲状腺癌患者进行过度诊断和治疗,同时及时发现那些需要积极治疗的晚期或高风险患者。近年来,随着新的临床和分子数据的不断出现,新的分期系统、新的预测工具以及新的治疗策略不断发展。本文参照当前的共识和指南建议,对DTC的热点问题进行综述,包括细胞病理和分子检测对手术决策的影响,分化型甲状腺癌的危险度分层,甲状腺微小乳头状癌的积极监测和手术选择,低危险分化型甲状腺癌的甲状腺手术和颈部淋巴结切除范围,放射性碘的选择性使用和放射性碘难治性疾病的分子靶向治疗。The incidence of differentiated thyroid cancer(DTC)continues to rise globally.Most of these incident cases are small localized papillary thyroid cancers with low risk,owing to the improvement and widespread use of diagnostic techniques.However,evidence from the past decade also suggests that the incidence and death rates of advanced thyroid cancer are on the rise.There is still much debate about the best treatment for differentiated thyroid cancer.At present,the main clinical challenge is to avoid overdiagnosis and treatment of low risk thyroid cancer patients,and identify high risk patients who need aggressive treatment.In recent years,with the emergence of new clinical and molecular data,new staging systems,new prediction tools and new treatment strategies have been developed.Based on the current consensus and guidelines,this paper summarizes the hot issues related to DTC,including active surveillance versus thyroid surgery for papillary thyroid microcarcinoma,risk stratification of differentiated thyroid carcinoma,the extent of thyroid surgery and lymphadenectomy for low risk differentiated thyroid cancer,the use of FNA and molecular testing to guide decision making about surgery,the selective use of radioiodine and the molecule targeting agents for radioactive iodine refractory disease.

关 键 词：分化型甲状腺癌 细胞病理 分子检测 甲状腺手术 放射性碘 分子靶向治疗 

分 类 号：R73[医药卫生—肿瘤]