甲状腺微小癌诊断与外科治疗规范化

Standardization of diagnosis and surgical treatment of thyroid microcarcinoma

甲状腺微小癌定义为结节直径≤1 cm的甲状腺癌。颈部超声的普遍应用增加了微小癌的检出率。常规的术前诊断方法包括临床体格检查,甲状腺超声检查和细针穿刺病理活检,恶性超声特征为细小钙化,边缘不规则。规范化的诊断内容应该包括哪一侧甲状腺叶,癌灶个数,最大直径,是否浸润包膜外,是否淋巴结转移,是否远处转移。甲状腺微小癌的外科治疗存在争议,规范化的外科治疗包括针对偶然发现的微小癌和非偶然发现的微小癌两方面,甲状腺近全切除或全切除是甲状腺癌的常规术式,但对于甲状腺微小癌甲状腺腺叶切除或次全切除是否需进一步手术或者是否需行颈部淋巴结清扫则由个体临床和病理特点决定。

Papillary thyroid microcarcinoma （PTMC） is defined as a papillary thyroid tumor measuring less than 10 mm in diameter. The use of neck ultrasonography in the evaluation of the thyroid has resulted in an increased detection rate of PTMC. Routine preoperative diagnostic methods include clinical examination, thyroid ultrasound and fine needle aspiration biopsy. Potential malignant nodule characteristics of ultrasound include microcalcifications and irregular margins. Standardized diagnosis of PTKC should include the location of thyroid nodule, tumor number, maximum diameter, extracapsular invasion, lymph node metastasis and distant metastasis. Standardized surgical treatment of PTMC （ including incidental and nonincidental PTMC ） remains controversial. Total or near-total thyroidectomy is recommended for thyroid carcinoma. However, in treating incidental or nonincidental PTMC, the need of further surgery and/or neck lymph node dissection after thyroid lobectomy or sub-total thyroidectomy should be based on individual clinical and pathological features.