关于甲状腺惰性病变临床诊疗策略的思与辩

Thinking and Discrimination on Clinical Strategy of Indolent Thyroid Lesions

随着对疾病认识的不断加深,恶性肿瘤中的惰性病变以其独特的生物学特征日益受到重视。以甲状腺癌为代表的相对惰性肿瘤,由于具有高发病率、慢进展及低死亡率的特点,引发了关于该类疾病是否被过度筛查、过度诊断及过度治疗的质疑。但临床上,何种类型的甲状腺癌可以界定为惰性病变,低危的甲状腺癌是否应该有针对性的临床管理策略都是现阶段的现实问题,亦是学术争论的焦点。通过梳理现有的国内外资料,提倡理性判断不同类型甲状腺癌的差异性,辨证考量早期筛查的必要性,充分评估临床实施诊疗策略的复杂性,以客观看待当前同时存在甲状腺癌过度医疗与医疗不足的状况,以期形成临床更优化、更规范的医患共同诊治决策。

With deeper understanding on disease,indolent lesions have been disputed because of their unique biological characteristics.Thyroid cancer is considered to be a relatively indolent tumor.Due to its high morbidity,slow progression and low mortality,it is questioned on extensive screening,over diagnosis and overtreatment.In fact,what kind of thyroid cancer can be defined as indolent lesions,and whether low-risk thyroid cancer should have targeted clinical management strategies are realistic issues and the focus of academic debate.Clinicians need to rationally judge the differences of thyroid cancer types,examine the necessity of early screening dialectically,fully evaluate the complexity of clinical medical strategies,and objectively look at the simultaneous situation of overtreatment and insufficient treatment,in order to form a more optimized and standardized shared decision making model.