2015美国甲状腺学会成人甲状腺结节与分化型甲状腺癌诊治指南精细版.pptx

《2015年ATA成人甲状腺结节及分化型甲状腺癌指南》 —Less is more; 2009: 80 recommendations; 434 citations 2015: 101 recommendations; 996 citations;1;1; Thyroid Nodule Risk Stratification: Sonographic pattern more important than growth ;超声;Thyroid function;甲状腺结节的良恶性评估及FNA指征;Solid, hypoechoic, irregular margins, Microcalcifications, taller than wide, Extrathyroidal extension;2009版指南FNA指征; 体积;分子基因检测 ;1;Surgical Management: Allowing for lobectomy in the treatment of thyroid cancer;;回顾性研究 Bilimoria等(52173例) TTx 的10年生存率稍优于甲状腺腺叶切除术 Haigh等(5432例) Barney等(23605例 Mendelsohn等 (22724例) TTx与甲状腺腺叶切除术生存率无显著差异;术式变化的因素;甲状腺腺叶切除术;甲状腺近全切术/全切术的选择;;中国PTMC密切观察适应症;肿瘤大小增大超过 3mm 出现临床淋巴结转移 患者改变意愿，要求手术 密切观察过程中若出现上述情况应考虑手术治疗;如何预测应行手术治疗的PTMC？;Management of Suspicious Lymph Nodes and Nodal Metastases: Focus on 8-10 mm;淋巴结清扫;淋巴结清扫;淋巴结清扫;Initial versus Dynamic Risk stratification: More low risk patients;AJCC/UICC staging;AJCC/UICC* staging System ? 预测疾病死亡率;甲状腺癌的分级;;Cooper et al, Thyroid 2009;低危风险:;中危风险;中危风险 高危亚型PTC（高细胞变异型）;Risk of Structural Disease Recurrence;1;Radioactive Iodine Therapy: Fewer patients, lower administered activities ;ATA低危风险的131I治疗选择;Do not routinely give RAI for “low risk” PTC or FTC* Weak Recommendation; Low Quality evidence Do not give RAI for unifocal Micro PTC* Strong Recommendation; Moderate Quality evidence Do not give RAI for multifocal Micro PTC* Weak Recommendation; Low Quality evidence *absent any other higher risk features ; 中危风险可考虑RAI清甲治疗 位于甲状腺内1– 4cm肿瘤伴淋巴结转移 其他高危征象 (结合年龄，肿瘤体积，淋巴结转移情况及病理提示为中危/高危风险或死亡) 不推荐，低质量证据 ; 高危风险应行RAI清甲治疗 远处转移 甲状腺腺外转移（无论其体积大小） 肿瘤体积4cm，甚至缺乏其他高危征??? 强力推荐，中等质量证据 ; ≥ 4 cm;1;Long-term Management: Less TSH suppression, less stimulated testing ;Low Risk;动态风险分层 ATA Response to Therapy：评估风险变化 (重新评估风险) ;Low Risk;;动态风险分层 ;甲状腺激素的抑制目标;Recurrent Nodal Metastases: Watchful waiting for small ones ;;微小淋巴结转移的管理; Advanced Disease: Expanded guidance ; The malignant/metastatic tissue does n