甲状腺结节的现代诊疗进展

绝大多数甲状腺结节都是经影像学检查无意间发现的,即使是良性甲状腺结节,也有必要进行治疗。临床医生需要综合患者的病史、体格检查及实验室、影像学或细胞学穿刺活检等检查结果尽可能明确诊断结节的良恶性。非手术微创治疗方法对于多数的良性结节行药物或放射性碘治疗如无水酒精注射(PEI)、激光光凝(ILP)、放射性碘消融(RFI)和微波消融(MWA)效果较好;而恶性或高度怀疑恶性及部分较大良性结节需行外科手术切除,根据结节的具体类型并结合各高危因素选择适当的切除范围,某些恶性结节术后还需进一步辅助碘131放射治疗并跟踪随访。本文综述了有关甲状腺结节的最新诊断和治疗进展,重点阐述了美国甲状腺协会关于甲状腺结节和分化型甲状腺癌的诊治指南的相关主张。

Progress in the Diagnosis and Treatment of Thyroid Nodules

ABSTRACT: Most of the thyroid nodules are found incidentally during unrelated radiographic studies. Even most thyroid nodules are benign, treatment are still of great importance. Clinicians should evaluate that a nodule is benign or malignant and definite diagnosis through the history, physical examination, laboratory test, imaging techniques or cytology biopsy results as far as possible. Most benign nodules only need medication or radioiodine treatment. In the last years, non surgical minimally invasive techniques have been a good choice, starting from percutaneous ethanol injection (PEI), to interstitial laser photocoagulation (ILP), radiofrequency ablation (RFA) and, most recently, microwave ablation (MWA). For malignant or highly suspected malignant and some benign large nodules, surgical resec- tion is required. And surgeons should select the appropriate extent of resection according to specific types of nodules and various risk fac- tors. Some malignant nodules need further assisted iodine 131 radiation therapy and follow-up after the opration. This article provide an up-date review of diagnostic approach and management of thyroid nodules, focusing on current algorithm in lights of the most recent published American Thyroid Association thyroid nodule and differentiated thyroid cancer management guidelines.