甲状腺结节与甲状腺癌的鉴别和最新诊疗方案——中国甲状腺结节和分化型甲状腺癌诊治指南解读

New protocol for the diagnosis and management of thyroid nodule and carcinoma——the Chinese management guidelines for patients with thyroid nodules and differentiated thyroid cancer

摘要:

甲状腺结节是一种临床常见病，近年来我国检出率明显增高，甲状腺癌的发病率也呈现增高的趋势。经B超检查发现的甲状腺结节患病率为20%～76%，其中甲状腺癌的患病率约为5%～15%。鉴别甲状腺结节的良恶性和评估对周围组织的损害是诊断的重点。收集完整病史有助于甲状腺结节发生甲状腺癌的危险评估。高分辨率超声检查是评估甲状腺结节的首选方法。穿刺活检是评估甲状腺结节良恶性准确性（83%）、特异性（92%）最高的检查。手术治疗、术后131I治疗和促甲状腺激素（TSH）抑制治疗是甲状腺癌的治疗方法。甲状腺结节和甲状腺癌应视具体情况安排不同时间间隔的随访。与中青年人群相比老年人群甲状腺结节的患病率增高，甲状腺癌的发生率低，治疗原则相同。

Abstract:

Thyroid nodule is a common clinical disease. In recent years, the detection rate of thyroid nodule, as well as the incidence of thyroid cancer, presents higher and higher in China. Thyroid nodule is confirmed with a prevalence of ultrasonic inspection of 20% to 76%, while, the incidence of thyroid cancer detected from thyroid nodule reaches 5% to 15%. Therefore, identifying benign or malignancy of the nodule, and the damage of surrounding tissue is of particularly importance. Risk factors of thyroid cancer developing from thyroid nodules could be evaluated by collecting complete medical history. This might do great help to arrange reasonable diagnosis and treatment. High resolution ultrasound evaluation is the preferred approach for thyroid nodule. Biopsy has the highest accuracy (83%) and specificity (92%) in assessing benign or malignancy of thyroid nodule. Other laboratory and imaging examination can play a supplementary role. Surgery, postoperative 131I therapy and thyroid stimulating hormone suppression therapy are most common treatments for thyroid cancer. Follow-up schedule of thyroid nodules and thyroid carcinoma should be arranged according to each specific situation. Though the prevalence of thyroid nodule is higher in the elderly than in young subjects, the incidence of thyroid carcinoma in the elderly is relatively lower. The therapeutic management for the elderly is the same as that for the young.