Indolent thyroid cancer: knowns and unknowns.
Indolent thyroid cancer: knowns and unknowns.
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DOI：
10.1186/s41199-016-0021-x
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发表时间：
2017-01-01
期刊：
影响因子：
--
通讯作者：
Desser, Terry S
中科院分区：
文献类型：
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作者：
Hahn, Lewis D;Kunder, Christian A;Desser, Terry S
由于对惰性甲状腺癌(即临床上可能微不足道的癌症)的检测和诊断增加，甲状腺癌的发病率正在迅速增加。预测甲状腺癌惰性行为的临床、放射学和病理学特征在很大程度上仍是未知和未被研究的。现有的临床病理分期系统在提供甲状腺癌治疗后的预后方面是有用的，但不是为预测懒惰行为而设计的，也不足以预测懒惰的行为。超声研究主要集中于区分恶性和良性结节；一些研究显示，利用超声特征预测懒惰的数据很有希望，但仍处于早期阶段。同样，分子研究正在发展，以更好地确定甲状腺癌的特征，并提高细针抽吸活组织检查的产量，但惰性甲状腺癌的确切标志物尚未确定。尽管如此，主动监测已被引入作为惰性甲状腺微小癌手术的替代方案，安全监测的方案正在制定中。由于增加对甲状腺癌的检测几乎是不可避免的，因此需要更多关于预测懒惰行为的研究，以避免过度治疗的流行。
Thyroid cancer incidence is rapidly increasing due to increased detection and diagnosis of indolent thyroid cancer, i.e. cancer that is likely to be clinically insignificant. Clinical, radiologic, and pathologic features predicting indolent behavior of thyroid cancer are still largely unknown and unstudied. Existing clinicopathologic staging systems are useful for providing prognosis in the context of treated thyroid cancer but are not designed for and are inadequate for predicting indolent behavior. Ultrasound studies have primarily focused on discrimination between malignant and benign nodules; some studies show promising data on using sonographic features for predicting indolence but are still in their early stages. Similarly, molecular studies are being developed to better characterize thyroid cancer and improve the yield of fine needle aspiration biopsy, but definite markers of indolent thyroid cancer have yet to be identified. Nonetheless, active surveillance has been introduced as an alternative to surgery in the case of indolent thyroid microcarcinoma, and protocols for safe surveillance are in development. As increased detection of thyroid cancer is all but inevitable, increased research on predicting indolent behavior is needed to avoid an epidemic of overtreatment.