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中华医学超声杂志(电子版) ›› 2017, Vol. 14 ›› Issue (04) : 245 -249. doi: 10.3877/cma.j.issn.1672-6448.2017.04.002

所属专题: 文献 指南共识

综述

国内外甲状腺结节超声诊治相关指南的比较与解读
许敏1, 邹学彬1, 李安华1,()   
  1. 1. 510060 广州,华南肿瘤学国家重点实验室 肿瘤医学协同创新中心 中山大学肿瘤防治中心超声心电科
  • 收稿日期:2016-11-19 出版日期:2017-04-01
  • 通信作者: 李安华

Comparisons and interpretations of the relevant guidelines for the diagnosis and treatment of thyroid nodules

Min Xu1, Xuebin Zou1, Anhua Li1()   

  • Received:2016-11-19 Published:2017-04-01
  • Corresponding author: Anhua Li
引用本文:

许敏, 邹学彬, 李安华. 国内外甲状腺结节超声诊治相关指南的比较与解读[J]. 中华医学超声杂志(电子版), 2017, 14(04): 245-249.

Min Xu, Xuebin Zou, Anhua Li. Comparisons and interpretations of the relevant guidelines for the diagnosis and treatment of thyroid nodules[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(04): 245-249.

表1 2015版ATA指南甲状腺结节恶性风险分层及FNAB标准
表2 2016版NCCN、AACE、KSThR指南甲状腺结节恶性风险分层及FNAB标准
表3 甲状腺结节与分化型甲状腺癌诊治指南超声相关部分比较
指南 高度怀疑恶性结节超声征象 可疑转移性淋巴结声像特征 恶性程度风险分层 FNAB指征 超声引导下介入治疗
ATA指南(2015) 钙化环缺损伴实性部分突出、甲状腺被膜受累 囊性改变、强回声、淋巴结变圆、周边血流 高度、中度、低度、极低度可疑恶性及良性 ≥1.0 cm PEI可用于治疗有压迫症状或影响外观的复发性囊性病灶
NCCN指南(2016) 低回声、血供丰富 没有提及 无影像学恶性度分级,有TNM ≥1.0 cm 没有提及
AACE指南(2016) 实性极低回声结节,甲状腺被膜受累,可疑区域淋巴结转移 没有提及 高度、中度、低度风险 ≥1.0 cm PEI可作为复发性囊性病灶的一线治疗方法。PLA和RFA治疗的适应证:实性或囊实性良性结节伴进行性增大、有症状、影响外观
中华医学会指南(2013) 实性低回声、血供丰富、晕圈缺如、颈部淋巴结超声影像异常 圆形、边界不规则或模糊、内部回声不均、出现钙化、皮髓质分界不清、淋巴门消失或囊性变等 没有提及 ≥1.0 cm PEI可用于良性囊肿和含有大量液体的甲状腺良性结节,但不推荐常规应用
CATO指南(2016) ? 没有提及 TI-RADS ≥0.5 cm 不推荐
KSThR指南(2016) ? 提出风险分级 K-TI-RADS(高度、中度、低度风险,良性) ≥1.0 cm 具有较高有效性及安全性,可成为替代手术的治疗方法
ESMO指南(2012) 实性低回声、血供丰富、晕环缺如 没有提及 支持2006版ETA、2009版ATA及2009版AJCC ≥1.0 cm 没有提及
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