甲状腺癌规范化诊治理念更新及其意义

The update concept and its significance for standardized diagnosis and management of thyroid cancer

近年来我国甲状腺癌发病率呈现增高的趋势,众多临床工作者都在积极探索诊断和治疗方法的创新,寻求更符合国情的诊治体系。2009年美国甲状腺学会(ATA)指南及2012年《中国甲状腺结节和分化型甲状腺癌指南》的出台,使我国甲状腺癌的诊治逐渐规范,诊治理念也随之发生变化。2014年ATA年会及将于2015年初发布的新版ATA指南,将甲状腺癌诊断方法由单纯使用超声发展为影像定位-细胞病理-分子靶标多层次早期诊断体系。治疗理念也由模糊的手术指证升级为更加依赖精确的疾病分期和风险分层,使甲状腺手术、淋巴结清扫方式更加有章可循。更多的学者不仅关注于提高甲状腺癌病人存活率,减少肿瘤残留或者复发、转移等伴随症状发病风险,而且更加关心低风险甲状腺癌病人尽量保留腺体功能,避免不必要的治疗。

ATA guidelines issued in 2009 and 2012 China thyroid nodules and differentiated thyroid cancer guidelines, making the diagnosis and treatment of thyroid cancer, gradually standardize the diagnosis and treatment concepts also will be changed. 2014 Annual Meeting of the American Thyroid Association and the new guidelines will be issued by ATA early 2015 （hereinafter referred to as the new guidelines）, the method for the diagnosis of thyroid cancer development by the simple use of ultrasound for image positioningeytopathology - multilevel molecular targets for early diagnosis system. Treatment concept is also vague surgery testily by upgrading to a more aecurate disease staging dependence and risk stratification, thyroid surgery, lymph node dissection methods, more rules to follow. More scholars not only focus on the symptoms associated with the risk of thyroid cancer patients to improve survival and reduce the residual or recurrent tumor and metastasis, and more concerned about the low-risk thyroid cancer patients try to retain gland function, to avoid unneeessary treatment.