2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: What is new and what has changed?
2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: What is new and what has changed?
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DOI：
10.1002/cncr.30360
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发表时间：
2017-02-01
期刊：
影响因子：
6.2
通讯作者：
Haugen, Bryan R.
中科院分区：
文献类型：
--
作者：
Haugen, Bryan R.
甲状腺结节非常常见，甲状腺癌目前是女性第五大癌症诊断。美国甲状腺协会领导了甲状腺结节和分化型甲状腺癌（DTC）患者管理指南的制定和修订。最新修订版发表在2016年1月的甲状腺杂志上。目前的指南有101条建议，8张图和17张表，希望对甲状腺结节和癌症患者的治疗有所帮助。美国甲状腺协会指南工作组的主要目标是使用现有证据来指导建议，但在证据的范围和强度内尽可能有用和实用。目前的审查重点是新的和重大修订的建议，可能会很好地改变临床实践。作者指出，在这次指南修订中出现了3个新的基本原则：1）甲状腺结节的管理，包括进行细针穿刺活检的决定以及随访的决定，将受到新开发的超声风险模式的严重影响; 2）DTC的长期管理沿着促甲状腺激素目标将受到4类治疗反应的严重影响;放射性碘难治性DTC患者的管理将分为4个基本决策组：应接受监测的患者、应接受定向治疗的患者、应接受全身治疗的患者和应进入临床试验的患者。癌症2017;123：372-381。(c)2015年美国甲状腺协会关于成人甲状腺结节和分化型甲状腺癌治疗的指南与之前的指南相比发生了重大变化。一些主要变化涉及甲状腺结节的超声风险模式，使用治疗反应来帮助指导长期管理，以及关于放射性碘难治性分化型甲状腺癌患者管理的新章节。
Thyroid nodules are very common, and thyroid cancer is currently the fifth leading cancer diagnosis in women. The American Thyroid Association has led the development and revision of guidelines for the management of patients with thyroid nodules and differentiated thyroid cancer (DTC). The most current revision was published in the January 2016 issue of the journal Thyroid. The current guidelines have 101 recommendations, with 8 figures and 17 tables that are hopefully helpful to those treating patients with thyroid nodules and cancer. The primary goals of the American Thyroid Association Guidelines Task Force were to use the current evidence to guide recommendations and yet be as helpful and practical as possible within the scope and strength of the evidence. The current review focuses on new and significantly revised recommendations that may very well change clinical practice. The author notes 3 new basic principles that have emerged in this guidelines revision: 1) the management of thyroid nodules, including the decision to perform a fine-needle aspiration biopsy as well as follow-up decision making, will be heavily influenced by the newly developed sonographic risk pattern; 2) the long-term management of DTC along with thyroid-stimulating hormone target goals will be heavily influenced by the 4 categories of response to therapy; and 3) the management of patients with radioactive iodine-refractory DTC will be divided into 4 basic decision-making groups: patients who should undergo monitoring, patients who should undergo directed therapies, patients who should undergo systemic therapies, and patients who should be offered entry into clinical trials. Cancer 2017;123:372-381. (c) 2016 American Cancer Society.The 2015 American Thyroid Association guidelines for the treatment of adults with thyroid nodules and differentiated thyroid cancer have changed significantly from previous guidelines. Some of the major changes concern sonographic risk patterns for thyroid nodules, the use of response to therapy to help to guide long-term management, and a new section regarding the management of patients with radioactive iodine-refractory differentiated thyroid cancer.